Fourteen patients suffering from chronic post-traumatic pain were examined and treated from both physical and mental viewpoints. The subjects consisted of 3 men and 11 women with the mean age of 44 years. The mean period from injury until initial examination at this department was 19 months. Neurologically, cranial nerve palsy was noted in 2 patients, whereas the other patients suffered from subjective symptoms without any distinct signs of abnormalities, including the results of auxiliary examinations. Psychological examinations indicated that the behavioral profiles of these patients were characterized by being neurotic with a high degree of anxiety and depression, strong tension in interpersonal relations, and a lack of rational judgment. In 11 patients behavioral therapy and other modes of psychosomatic treatment were carried out in conjunction with physical therapy. This treatment regimen was therapeutically effective in alleviating pain or promoting awareness of psychological factors in 8 of these patients. Although the distinction between chronic pain and psychogenic pain is difficult, we concluded, based on the review of various literature, that : (1) chronic post-traumatic pain should be treated as a psychosomatic disease regardless of the nature of neurotic and depressive factors, and (2) chronic pain is one type of syndrome generated by the complex interplay of the biological response and psychogenic response of the patient.

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The aim of this study is to characterize the clinical manifestations of relatively early onset of eating disorders in children. Twenty four cases (6 boys, 18 girls) visited firstly the department of pediatrics of Saitama Medical School Hospital or Children's Hospital at Yorii with abnormal eating behavior and weight loss at 7 to 15 years of age. The diagnostic criteria for anorexia nervosa (AN) of committee on AN (Ministry of Health and Welfare, 1990) is met in 10 cases, the criteria for bulimia nervosa (BN) (DSM-III-R, 1987) in 2 cases and both criteria of AN and BN in 2 cases. Other 10 are suspected or atypical AN. They are classified into 4 types by eating behaviors at the initial visit, and describe their clinical manifestations and prognosis. 1. Voluntary dieting type (1 boy, 7 girls, 12.6±L1.3 years of age at the onset). They restrict food intake voluntarily to have lean figure, and manifest strong fear of becoming fat and abnormal eating behaviors. Three of them have good prognosis, but other 5 have abnomal eating behavior and/or maladjustment in school life. 2. Appetite loss type (1 boy, 6 girls, 12.3±l.2 years of age at the onset). They complain of anorexia and eat less amount. It is suggested from their background of onset that they have latent desire to reduce their body weight. Most of them complain of headache. abdominal pain, nausea or other symptoms, but their prognosis was much better than that of other types. 3. Eating refusal type (2 boys, 3 girls, 10.2±2.5 years of age at the onset). They refuse to eat stubbornly without desire for lean figure or dislike their body shape. Their mean age at the onset is youngest among 4 types, and 3 girls start eating disorder at the premenarche. Although abnormal eating behavior improve early, adjustment to school life is poor in 4 cases. 4. Binge eating and vomiting type (2 boys, 2 girls, 13.5±O.5 years of age at the ontet). Their emaciation is not so severe but binge eating and vomiting are evident with desire for lean figure. Their mean age at the onset is oldest among 4 types. All of them have pubertal onset, and manifest school refusal and/or abnormal social behavior. The short-term prognosis (24.5±13.3 months' duration) of 24 cases is good in 10 cases (42%). Their abnormal eating behaviors improve early, their outcomes are good in physical status and in social adjustment. The poor prognosis is related to the loss of weight more than - 15% of standard body weight in 2 cases (8%), continued abnormal eating behaviors in 7 cases (29%), social maladjustment in 10 cases (42%) and to males.

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A case is presented who has recovered from depressive neurosis by the photic feedback (PFB) therapy. The PFB system was developed in order to make body and mind relaxed by enhancing alpha waves of electroencephalogram (EEG) utilizing light signals made from subjects' own EEG. The patient was a 61-year-old male who had developed depressive neurotic symptomatology including insomnia, depressed mood, irritability and gastralgia five years before the first visit under stressful situations accompanying an annexation of his company and suicide of its president. His symptoms had persisted since then because he had been experiencing various distressful life events such as his wife's suffering from subarachnoidal hemorrhage, his symptoms including chest discomfort and palpitations diagnosed as 'angina pectoris', and death of his father and one of his classmates. We have treated this case by using PFB system following the A-B-A-B single-case experimental design. A questionnaire was used as psychological indices measuring depressive mood, cognitive and perceived physiological aspects of anxiety and irritability. Various physiological measures were also monitored such as EEG, skin surface temperature (SST), skin conductance level (GSR), plethysmogram (PLE), the coefficient of variance of the component of respiratory related sinus arrythmia (CCV-HF) and Mayer wave related sinus arrythmia (CCV-LF). Scores of psychological indices, especially depressive mood, decreased within each session until the middle period of the whole treatment. Increases of SST and CCV-HF were also observed, and these psychological and physiological changes were consistent with the state of relaxation. Sleep disturbance such as talking and roaring out during his sleep was improved after one session. and depressive mood was also improved in the first half of the treatment. However, depressive mood was again aggravated and intense anxiety about cardiac illness also appeared in the latter half of it because his close relatives and friends died one after another then. His conditions began to get better after we added cognitive interventions and extended feedback time of the therapy against this situation. We terminated the PFB therapy in the 41 st week. It is hypothesized that the efficacy of the PFB therapy is derived from relaxation induced by alpha wave enhancement. However, how alpha wave enhancement induces relaxation or what relaxation really is still remains to be elucidated. What kind of illnesses can be effectively treated by the PFB therapy should also be made clearer in the future.

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Various complex personality disorders are found in eating disorder. Many impulsive behaviors are observed in cases complicated with borderline personality disorder, and their prognostic course is tended to be delayed. In this paper. we followed up the progress of symptoms in 2 cases with eating disorder for approximately 6 years, and carried out Szondi test which is one of the psychological tests using the projective technique for evaluating drive variations. The treatment of symptoms in these 2 cases had been delayed, and the pathology of borderline personality disorder was observed after 6 years. Many variations of clinical symptoms were obtained by Szondi test, and the characteristics of borderline personality disorder such as elevation of drive-excitement, antisocial tendency and anxiety about abandonment were also evaluated by Szondi test. It was considered that Szondi test should be utilized in the prognostic research because it is useful for evaluating the drive risk in various diseases.

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Although psychosocia_1 stressors have long been felt to affect diabetes, prior research in this area had been hampered by methodologic difficulties. This study was designed in order to study the relationship between psychosocial factors and metabolic control of diabetes mellitus. Seventy-four middle or old aged outpatients with non-insulin dependent diabetes mellitus (NIDDM) were studied at the Asahi Life Foundation Institute for Diabetes Care and Research. The authors developed a "Diabetic Checklist" self-report questionnaire that measured psychosocial factors and demographic data. Results from this questionnaire and several psychological tests were compared to measurements of glycosylated hemoglobin (HbAic). Multivariate statistical analysis, the Quantification Type I method, was done in order to minimize the methodologic problems found in prior studies. This analysis revealed that the combination of six items (egogram, occupation, body weight, therapy method, diabetic education and eating behavior) could most accurately estimate diabetic control (R-squared=0.576). The egogram pattern based on transactional analysis which indicates the pattern of personal relationships, was felt to be the most useful measurement. The authors conclude that useful information to evaluate diabetic control may be observed from the study of certain psychosocial factors and are planning for the prospective study in this area.

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Fifty-four cases were consulted on during a two-year period by a psychosomatic medicine consultation service. The present study was conducted in order to characterize these referrals. These were patients who were admitted to medical/surgical services exhibited psychosomatic symptomatology. The data base included patient information recorded on the consultation service records, patient charts, records of consultation conference and a clinical data sheet for psychosomatic medicine. The sex ratio was 0.7 male to 1.0 female, with an age range of 13-82 years old. 12 patients were diagnosed as "depressive reaction" while others had various psychosomatic symptomatology. Using DSM-iii-R criteria, 18 patients were diagnosed as somatoform disorder, 9 patients had various mood disorders, and 8 had adjustment disorder. 15 patients met the criteria for DSM-iii-R personality disorder. Severity of psychosocial stressors ranged from 2 to 5,and global assessment of functioning was 50 to 80. Only one consultation was required in 24 cases and less than three consultations in 35 cases. Most cases needed relatively short term consultation. 24 cases required less than one week while 40 cases required up to 1 month. Consultation requests were made largely from the medical service (38 cases) , and the remainder spanned the gamut of services. In 29 cases, the referring clinicians wanted some assessment regarding the relationship between physical symptoms (i. e., abdominal pain, chest pain, diarrhea, hypertension, dizziness, and numbness) and psychosocial factors. They also requested advice regarding treatment. The recommended treatments included psychosocial interventions. phar- macotherapy, and in some cases autogenic training or psychotherapy. In this article the general aspects of the treatment of 54 patients and detailed aspects of the treatment of 2 patients are described. The data of this study indicate that the availability of a psychosomatic consultation service is important in the general medical setting. Further study will identify those factors that will aid in the improvement of these consultation services.

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In cognitive-behavioral programs designed for chronic pain patients, Iittle is known about the mechanism of psychological changes which occur during therapy, though the idea that pain behaviors are decreased is widely accepted. We have conducted a three-week outpatient program for twenty-three musculoskeletal chronic pain patients. We compared pre- and post-treatment values of VAS (visual analogue scale). MMPI profiles, and SDS scores of all patients in order to investigate what happens from a psychological point of view. Responses to each item of the MMPI and SDS were also examined to distinguish whether they had changed after the program. We found that VAS values, MMPI F, Hs, D, Hy, Pd, Sc, MAS scores, and total SDS scores had decreased significantly, whereas MMPI Lb and As had not change. Patients significantly changed their answers to 12 items of the MMPI and 6 items of the SDS, mainly concerning somatic preoccupation and depressed mood. We conclude that a programmed reconditioning exercise alters the incapacitated body image and that the change of cognition of pain in chronic pain patients improves their depressive state. We suggest that this approach may amend the mental as well as the physical status of chronic pain patients though further research focused on detailed cognitive changes, and long-term follow-up of this program are needed.

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Eating disorders are multidimensional disease, but recent increase of the disease is mainly explained by the effect of socio-cultural pressure for thinness. We suggested in a previous study of junior-high-school students that they are strongly affected by the socio-cultural pressure. Mass media is one of the most effective factors to spread the pressure. It is possible that the thin standards in female to be emphasized by mass media stimulate female to diet. However, no studies have ever tried to investigate the relationship between ideal body image of pubertal female and body size of models to be informed by mass media. Then we investigated real body weight, desirable body weight and appropriate body weight of 687 students (347 male, 340 female) in a public junior-high-school and compared three body weights with so-called standard body weight ((height-100)xO.9), and cosmetic body weight (height-110). In addition to these, in female three body weights were compared with idol talent's body weight (n=109) which was printed in student-oriented entertainment magazines. The purpose of this paper is to identify what weight they think is standard and ideal, and how different body weight image is between males and females. There was no difference between actual, appropriate and desirable body weight in male students. In female students, there was no difference between actual and appropriate body weight, but desirable body weight was lower than actual and appropriate body weight and was inclined toward idol talent's body weight. Neither the so-called standard body weight nor the cosmetic body weight was similar to appropriate body weight in either sexes. We may, therefore, reasonably conclude that only female students have much difference between actual and ideal body weight images and that information from mass media affects their ideal image. This may be related to the fact that many eating disorders are found in females but rare in males. As a countermeasure of recent increase of eating disorders, we consider that it is insufficient to treat them with individual psychopathology and that it is necessary to discuss socio-cultural problems.

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Social pressure for thinness has been emphasized as a cause of recent increase in the prevalence of eating disorders. We have previously found that female junior-high-school students are strongly possessed with their body weight (BW) and body physique and that their self-esteem is associated with their body image. However, only a little fraction of people actually suffer from eating disorders, indicating that individual differences in the reactivity to the social pressure are also important in the etiology of the disease. This study aimed to examine the hypothesis that the BW over'estimation is associated with low self-esteem independently of actual BW in adolescent females. We performed a questionnaire survey on the relationship between self-esteem and body image in 714 students (361 male, 353 female) in an urban coeducational public junior-high-school. The self-esteem was evaluated by means of Kajita's self-esteem scale. The body image was evaluated from the relationship between obesity index and an adjective expression of physique (fat, average, lean) selected by subjects. Based on the relationship between obesity index and adjective expression of physique, subjects were divided into three groups as follow : "over-estimators" were as- signed when "fat" was selected by subjects with an obesity index of < 0% and when "average" was selected by those with an obesity index of < -20% ; in the opposite cases assigned were "under-estimators"; and otherwise "approximate-estimators" were assigned. Additionally, the subjects in "appropriate-estimator" with an obesity index of < 0% were specially defined as "nonover-estimators". Cluster analysis performed on the responses to 23 items of the self-esteem scale showed that the items could be divided into three categories, which were respectively named "self-acceptance", "superiority", and "defense". The appropriate-estimators were 94.7 and 87.8% of male and fe-male students, respectively, whereas the under-estimators were 3.5 and O% and the over-estimators were 1.8 and 12.2%, respectively (p < 0.001). The frequency of over-estimator increased with advancing school grade in the female students (7.l%, 9.6%, and 19.0% for 1 st, 2 nd and 3 rd grade ; p < 0.018), but no significant difference was found in the male students. Analysis focused on the differences between the over- and non-over-estimators in the female subjects revealed that the over-estimators was lower in the self-acceptance score than the non-over-estimators (p=0.022), although no differences was found in the superiority or defense scores. Stepwise discriminant analysis revealed that self-acceptance was a significant discriminator between the two groups even when obesity index and school grade were forced to enter (p < 0.001). These results not only confirm our previous finding that female students desire their BW Iower than medically ideal / BW but also support the hypothesis that low self-acceptance may impair the acceptance of bodyimage and result in the over-estimation of BW in adolescent females.

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Behavioral therapy (chiefly operant conditioning and desensitization' was applied to 3 cases of lrritable Bowel Syndrome, predominant gas symptom, with school maladjustment. Five therapeutic points were demonstrated by this study. (1) The common cognition that attending classes had therapeutic significance was established between the therapists and the patient. (2) The therapist, parents, and school teachers were careful not to scold patients for either being late or leaving school earlier than usual. (3) Graduation from high school, without worrying about entrance examinations for university, was established as the goal for all patients. (4) Importance was attached to attending extracurricular events after regular school hours whenever possible. (5) The therapist made a special effort to praise patients for attending classes no matter how short it was. On the basis of these five therapeutic points, sliding stimulation for going to school (desensitization) was carried out. Finally all patients were able to go to school or return to society. Through these three cases, the significance of the behavioral therapy for irritable bowel syndrome was discussed.

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