Dr. Samuel Pfeifer
Klinik Sonnenhalde, CH-4125 Riehen, Switzerland
Between normal psychology and illness

The salt of the earth
French writer Marcel Proust
(1871 - 1922)

Highly sensitive people
Marilyn Monroe
Yves Saint Laurent
Diana

„I am very sensitive“ - POSITIVE
 finely tuned to others, tender hearted
 understanding, susceptible
 intensive emotions
 deep perceptions and passions
 touched by the beauty of nature, music, art, poetry, film, relationships.
 not hardened against the suffering of other people
 sensitive for the transcendent.

I am overly sensitive – negative 1
 overreacting
 vulnerable – easily hurt
 reading between the lines
 thinking too much - ruminating
 introverted and shy
 anxious, fearful
 not robust / no power reserves
 at my limits
 everything is coming too close
 defenseless

I am overly sensitive – neg 2
 often so overwhelmed that I cannot speak
 negative perceptions of other people
 tendency to overreact
 touchy, irritable , moody
 easily exhausted
 feelings cause physical discomfort
 etc.
Test for Sensitivity (E.N. Aron)

„The highly sensitive person“
– German psychiatrist W. Klages 1978

Existence between normal psychology and psychopathology.
 beyond the psychologically understandable, but do not reach the degree of psychiatric illness.

Sensitive perceptions
– causing intensive feelings and reactions
 smell
 taste
 auditory sense
 visual sense
 touch
 synaesthesia
 pathological startle reflex

Peculiarities of highly sensitive persons

Intensive struggle with verbal expression
 increased exhaustion
 frequent mood swings, irritability
 sexuality and inhibition
 paranormal sensitivity

When sensitivity turns into illness
– negative impact on

Ability to enjoy

Ability to relate

Ability to work

The changing meaning of „neurosis“
 until 1979: Definition based on the possible causes (mother, early trauma, sexual conflicts)

DSM-III (1980): description of symptoms, the term „neurosis“ is dropped
 New term: „Disorder“: e.g. „anxiety disorder“, „obsessive-compulsive disorder“,
„dysthymia“
BUT: Problems have remained the same

Descriptive definition of „neurosis“
 psychological disorder with anxiety, obsessions, mood swings, increased sensitivity
 inhibition, insecurity, conflictuous
 reality testing is intact
 disorders of somatic functions
 reduced performance at work or social role
 „difficult“ relationships
 symptoms persist or recur
 not a transient reaction to stress

Common features
Ambivalence
Impaired contact
Physical
Complaints
Psychosomatics
Reduced ability to perform
Inhibitions
Emotional lability

New terms

Subclinical disorders

Atypical depressions
 “Masked” depression

Subsyndromal disorders

Spectrum Disorders

Subthreshold Disorders

Spectrum Disorders
Depression
Bulimia-
Anorexia
OCD
Panic-
Agoraphobia
Migraine gastro-intestinal
Social
Phobia evtl ADHD?

Criteria of Spectrum Disorders

Criteria for the classic disorder are not fully present.

Symptoms are either limited or isolated, however combined with depressive mood.

Symptoms lead to impairment in social relations, work performance or other important areas of life.
 Symptoms lead to “emotionally loaded relationships” with dependence and social conflict.

Spectrum healthy aspects threshold subthreshold
• Personality problem
• isolated symptoms atypical
Disorder suffering classic syndrome
Core syndrome

Course of illness threshold
Illness episodes
Sensitization / Vulnerability
Later triggers (subklinical)
First trigger (Trauma) chronic

Development
Personality
Temperament
„Vulnerable“
Personality
Psychosocial environment
Stress
Sensitive Crisis

Sensitive Syndromes
Somatization
Emotional
Instability
Depression
Exhaustion
Ansiety
Disorders
Phobias
Obsessive-
Compulsive
Disorders
Anorexia
Bulimia
ILLNESS
Somatic
Syndromes
Migraine
Gastrointestinal disorders

Sensitization and the problem of pain a)Enhanced***** Erhöhte
Erregbarkeit der
Rückenmarksneuronen nach einer Verletzung b) Vergrösserung der
Empfindungsfelder der
Neuronen c) Verminderte
Schmerzschwelle d) Aufbau neuer afferenter
Inputs

Pain sensitization

Individual differences in pain processing

Nociceptor signaling pain

Pain threshold is lowered

Influential factors: Bradykinin, Prostaglandin E2 and Serotonin. When the concentration of these substances is exceeding a certain limit, their will be a pain sensation.

However, even when the threshold is not yet reached, even minor concentrations of these substances can increase the irritability of nociceptors --- PAIN SENSITIZATION.

Nociceptive feedback loops
Bradykinin (+)
Prostaglandin E2 (+)
Serotonin (+)
Pain stimuli nociceptors Blood vessel
Substance P

„Kindling“ and Sensitization

Kindling describes a phenomenon in which relatively minor and repeated stimuli lead to a profound alteration in brain function resulting in epileptical seizures.

The effects are not only local. There are also neuronal changes in distant brain areas.

Synaptic plasticity leads to „sensitization“ of the brain, even without manifest external stimuli.

Steps of Sensitization
GENETIC DISPOSITION
Intracellular and neurobiological changes
TRAUMA
Synaptic plasticitiy –
Shift in the balance of
Neurotransmitters
Neuroanatomic changes
(Adrenal gland in Depression,
Hippocampus in PTDS) persisting psychological sensitivity
Reduced Stresstolerance
Altered stress reaction somatoform symptoms

Applicability for psychological disorders

Psychodynamic concepts and clinical experience can be brought in line with neurobiological models.

They provide an explanation for the course of socalled „endogenous“ disorders (such as bipolar disorder) which can relapse without adequate external stimulus.
 They provide a model for „sub-threshold disorders“ in psychosomatic medicine – helping to understand and support patients with atypical syndromes.

Sensitization in the psychiatric literature

Anxiety sensitivity

Rejection Sensitivity & Interpersonal sensitivity. -- Atypical Dep.
 „Central sensitization syndromes“ –
Fibromyalgia and other pain syndromes

Affective disorders and stress supersensitivity

Transduction of psychosocial stress (R.M. Post)

The Goal: Living with limitations
Tasks
Sensitive
Personality
Ressources
Excessive demands
Stress
Life Events
Decompensation
„tipping the balance“

Protecting yourself
1. Find a balance between overactivity and regression!
2. Learn to understand your body‘s language!
3. Accept the limitations of your sensitivity!
4. Do not take everything too personal!
5. Take time to relax and to enjoy!
6. Do not take too much responsibility!
7. Explain your condition to others!
8. Recognize your shadow and work at improving your weaknesses.

(quote of a patient)

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Literature
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Aron E.N. (1996). The Highly Sensitive Person. How to thrive when the world overwhelms you. New York: Broadway.
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