[Risk factors for the development of neurotic disease. A contribution to research on its psychoanalytic genesis]

As a contribution to the psychoanalytic investigation of the origins of disease a group of "Inanspruchnahmepatienten" (patients availing themselves of the services provided by psychiatric institutions) (n = 458) was compared to a group of controls (n = 448), equal to the test group with regard to age, sex, and social status, the members of which had declared to feel psychically healthy and not in need of either psychotherapy or psychiatric treatment. The objective of this comparison was to ascertain the sum total of such risk variables, designated in advance and a priori assessed, which after many years of psychoanalytic experience may be considered as highly stress-intensive life events influencing the development of a child. The risk variables in question are described and the instruments used in the recording of the documentation are delineated. Six hypotheses were examined to exclude accidental results. Patients suffering from neurotic complaints have been more frequently exposed to certain stress factors in childhood and adolescence than psychically healthy subjects. Subjects suffering from neurotic complaints (independently of the psychopathologic condition of their parents) have been more frequently exposed to certain stress factors in childhood and adolescence than psychically healthy subjects. Within a group of patients subjects with a high stress index display more severe symptoms of disorder than those with a low stress index. In patients with a high stress index incidence of neurotic symptoms is observed earlier than in patients with a low stress index. For subjects who temporarily do not feel psychically ill or in need of treatment there is nevertheless a connection between the level of the risk index and any given early symptoms having occurred during childhood and adolescence. For subjects who temporarily do not feel psychically ill or in need of treatment there is nevertheless a connection between the level of the risk index and the psychic and psychosomatic complaints registered in the list of complaints. From all six of these hypotheses accidental results could be statistically excluded or, in other words: all respective zero-hypotheses were rejected. On the basis of the here described results of the investigation it may be assumed that the variables designated, a priori assessed, and combined into a sum of risks or a risk index, were indeed of causal significance for the development of a psychosocial disposition toward risk situations which in the adult promotes the development of psychoneurotic or psychosomatic symptoms.