Psychogenic pain conditions. Defense structure and taxonomic subgroups]

According to the results of the prospective Grant-Study the maturity of the individually available defence mechanisms has an essential influence on both physical and psychic well-being. Psychogenic pain patients are characterized by a "turning against self": an immature defense mechanism. By means of a cluster analysis, three taxonomic subgroups (types A, B, C) were defined. Type A is characterized by immature defense mechanisms (projection, turning against self and against object) and type C by neurotic defances (reaction formation and intellectualization), whereas type B manifests both intellectualization and a turning against self. Raised scores for anxiety, abnormal illness behaviour, depressive self-image, depressive mood and suicidal ideas are additional features which distinguish types A and B from type C. In contrast to type B, type A shows a negative social resonance, "doctor shopping" and drug abuse. The diagnostic differentiation of types A, B and C could be the basis of a differential indication to the different psychotherapeutic treatment approaches to chronic pain patients.