Somatoform pain disorders are strongly associated with adverse, mostly traumatic childhood experiences. Little is known, however, about the psychodynamic background, for example, with regard to defence, affect regulation, and traumatic representations. As part of a qualitative study in which 13 patients with somatoform disorder were investigated, we compared the interviews and drawings by the two patients which featured the most pictorial codes for deaffectualization as a defence of the autistoid type of early disorders with the two patients that displayed the fewest codes for deaffectualization. These patients suffered from a more mature, non-autistoid disorder. The drawings were analyzed according to the Visual Grounded Theory, the interviews according to Content Analysis. We used the qualitative atlas.ti-software. In the two patients with a high evidence of pictorial deaffectualization, a correspondence was found between the deaffectualization and the type of pain sensation: Physical movements led to an increase in pain. The affective as well as the physical rigidity may have been intended to avoid the body image's fragmentation. The drawings by the more mature patients showed strong, partly violent interactions. In the narratives, the patients tended more to report feelings of agitation; generally, more physical movements could be allowed. In all four patients, a considerable correspondence was identified between the drawings and the narratives about physical pain. The dimension of the imaginary was determined both physically (on the level of the body image) and pictorially (on the level of the mental image) through the regulation of traumatic affects.

中文翻译：

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别动了！患有躯体形式障碍的患者的图片和叙述中的疼痛、身体和创伤

躯体形式疼痛障碍与不良的、主要是创伤性的童年经历密切相关。然而，人们对心理动力学背景知之甚少，例如，关于防御、情感调节和创伤表征。作为一项对 13 名躯体形式障碍患者进行调查的定性研究的一部分，我们比较了两名患者的访谈和绘画，这两名患者的访谈和绘图具有最多的图像代码，用于防御自闭症类型的早期疾病，而这两名患者显示最少的失效代码。这些患者患有更成熟的非自闭症障碍。图纸根据视觉扎根理论进行分析，访谈根据内容分析。我们使用了定性的 atlas.ti 软件。在两名具有高度图像缺失证据的患者中，发现缺失与疼痛感觉类型之间存在对应关系：身体运动导致疼痛增加。情感和身体上的僵化可能是为了避免身体形象的碎片化。较成熟患者的绘画表现出强烈的、部分暴力的相互作用。在叙述中，患者更倾向于报告激动的感觉；一般来说，可以允许更多的身体运动。在所有四名患者中，在图画和关于身体疼痛的叙述之间发现了相当大的对应关系。想象的维度是通过调节创伤性影响在物理上（在身体意象水平上）和图像上（在心理意象水平上）确定的。