Dr. Samuel Pfeifer

1. Dr. Samuel Pfeifer Klinik Sonnenhalde, CH-4125 Riehen, Switzerland The concept of Sensitivity Between normal psychology and illness

2. The salt of the earth „The exalted and deplorable family of the highly sensitive is the salt of the earth“ French writer Marcel Proust(1871 - 1922)

3. Highly sensitive people Diana Marilyn Monroe Yves Saint Laurent

4. Vincent van Gogh

5. „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.

6. 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

7. 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)

8. „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.

9. Sensitive perceptions • causing intensive feelings and reactions • smell • taste • auditory sense • visual sense • touch • synaesthesia • pathological startle reflex according to Klages

10. Peculiarities of highly sensitive persons • Intensive struggle with verbal expression • increased exhaustion • frequent mood swings, irritability • sexuality and inhibition • paranormal sensitivity according to Klages

11. „Neurosis“ When sensitivity turns into illness • negative impact on • Ability to enjoy • Ability to relate • Ability to work

12. BUT: Problems have remained the same 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“

13. 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

14. Ambivalence Impairedcontact Inhibitions PhysicalComplaints Emotionallability Reducedability toperform Common features Psychosomatics

15. New terms • Subclinical disorders • Atypical depressions • “Masked” depression • Subsyndromal disorders • Spectrum Disorders • Subthreshold Disorders

16. Spectrum Disorders Depression Bulimia-Anorexia OCD SocialPhobia Panic-Agoraphobia Migraine -gastro-intestinal evtl ADHD?

17. 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.

18. threshold subthreshold atypical classic syndrome • Personality problem • isolated symptoms Coresyndrome Spectrum healthy aspects Disordersuffering

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

20. PersonalityTemperament Psychosocialenvironment Development „Vulnerable“Personality Stress Sensitive Crisis

21. Sensitive Syndromes SomaticSyndromesMigraineGastro-intestinal disorders Somatization Emotional Instability Anorexia Bulimia Depression Exhaustion Ansiety Disorders Phobias Obsessive-CompulsiveDisorders ILLNESS

22. 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 Quelle: Staud R. (2005). The neurobiology of chronic musculosceletal pain (including chronic regional pain). In: Wallace DJ & Clauw DJ (eds.) Fibromyalgia & Other Central Pain Syndromes. Philadelphia: Lippincott Williams & Wilkins. S. 45 - 62.

23. 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.

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

25. „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.

26. Steps of Sensitization GENETIC DISPOSITION Intracellular and neurobiological changes Synaptic plasticitiy – Shift in the balance ofNeurotransmitters Neuroanatomic changes(Adrenal gland in Depression, Hippocampus in PTDS) TRAUMA Reduced StresstoleranceAltered stress reactionsomatoform symptoms persisting psychologicalsensitivity

27. 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 so-called „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.

28. 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

29. Transduction of psychosocial stress (R.M. Post)

30. Coping withhigh sensitivity

31. Tasks SensitivePersonality Ressources The Goal: Living with limitations Decompensation „tipping the balance“ Excessive demands Stress Life Events

32. 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.

33. “I consider it as my strength to accept my weaknesses.” (quote of a patient)

34. Download this presentation Interesting texts, ressources, links can be found on this homepage: www.hsperson.com

35. Literature • Aron E.N. (1996). The Highly Sensitive Person. How to thrive when the world overwhelms you. New York: Broadway. • Aron E.N. (2000). The Highly Sensitive Person in Love. New York: Broadway. • Aron E.N., & Aron A. (1997). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology 73:345–368. • Rossi J 3rd. - Sensitization induced by kindling and kindling-related phenomena as a model for multiple chemical sensitivity. Toxicology. 1996 Jul 17;111(1-3):87-100. Review. • Bell IR, Miller CS, Schwartz GE. An olfactory-limbic model of multiple chemical sensitivity syndrome: possible relationships to kindling and affective spectrum disorders. Biol Psychiatry 32:218-242, 1992. • Post RM, Weiss SR.: Sensitization and kindling phenomena in mood, anxiety, and obsessive-compulsive disorders: the role of serotonergic mechanisms in illness progression. Biol Psychiatry. 1998 ;44(3):193-206. • Pietrobon D.: Migraine: new molecular mechanisms. Neuroscientist. 2005; 11(4):373-86. • Yehuda R.: Biology of posttraumatic stress disorder. J Clin Psychiatry. 2001;62 Suppl 17:41-46. • Simmons DA, Broderick PA.: Cytokines, stressors, and clinical depression: augmented adaptation responses underlie depression pathogenesis. Prog Neuropsychopharmacol Biol Psychiatry. 2005 Jun;29(5):793-807. • Maier SF, Watkins LR: Stressor controllability and learned helplessness: the roles of the dorsal raphe nucleus, serotonin, and corticotropin-releasing factor. Neurosci Biobehav Rev. 2005;29(4-5):829 - 841. • Anisman H, Merali Z, Poulter MO, Hayley S.: Cytokines as a precipitant of depressive illness: animal and human studies. Curr Pharm Des. 2005;11(8):963-972. • Anisman H, Merali Z.: Cytokines, stress and depressive illness: brain-immune interactions. Ann Med. 2003;35(1):2-11. • Staud R. (2005). The neurobiology of chronic musculosceletal pain (including chronic regional pain). In: Wallace DJ & Clauw DJ (eds.) Fibromyalgia & Other Central Pain Syndromes. Philadelphia: Lippincott Williams & Wilkins. S. 45 - 62. • Stahl S.M. (2003): Here today and not gone tomorrow: the curse of chronic pain and other central sensitization syndromes. Journal of Clinical Psychiatry 64:863-864.