[Psychogenic thoracic pain attacks. Pathogenesis, follow-up, therapy]

Over a five-month period a 10-year-old girl presented repeatedly with attacks of chest pain that were eventually diagnosed as a conversion disorder (DSM-III-R). A detailed case report of the (just) three sessions with both mother and daughter is given and the process of identifying the conflict constellation (death of a loved one, reproachful attitude toward the mother), aspects of primary and secondary gain, and factors influencing choice and localization of the pain symptoms (models: father and brother) are discussed. The therapeutic lead-in was achieved by noticing and inquiring about the patient's equivocal use of the term "joke" during an interview and in a projective sentence completion test. The therapeutic approach comprised psychoanalytically oriented components, elements of family therapy, suggestive measures, exercises and counseling. Over a follow-up period of two years the patient remained symptom-free and her further development was unproblematic. Aspects of this case that are typical of conversion disorder and factors indicating a good prognosis are discussed with reference to the literature.