Die Spezifischen Phobien stellen die häufigste Gruppe der Angststörungen dar. Die Angst vor dem Verschlucken bzw. dem Ersticken wurde jedoch nur sehr selten beschrieben. Bei der Behandlung der Spezifischen Phobien wird fast immer eine Konfrontation in vivo eingesetzt. Die Angst vor dem Verschlucken scheint aber eine der Spezifischen Phobien zu sein, bei der eine Konfrontation schwierig ist. Die hier vorgestellte Fallgeschichte schildert eine mögliche Vorgehensweise, die Ängste vor dem Verschlucken mit einer Reizkonfrontation in vivo zu behandeln. Dabei werden die verschiedenen Schwierigkeiten, die aufgetreten sind, und ihre Lösungen geschildert. Die Therapie wurde erfolgreich abgeschlossen, und auch die Ergebnisse der Nachuntersuchungen zeigten eine stabile Verbesserung. / Specific phobias are the most common anxiety disorders. However, the fear of swallowing the wrong way and choking has rarely been described. Specific phobias are usually treated using exposure therapy. The excessive fear of swallowing the wrong way does not seem to be very well suited for an exposure in vivo. In this case study, a patient afflicted with the fear of swallowing and choking was treated with flooding. The various difficulties encountered during treatment and their remedies will be described. The therapy was successful. The patient showed stable and lasting improvements at posttreatment and at one-year follow-up. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Aus der Einleitung: "In den vergangenen 15 Jahren sind in verschiedenen Ländern der Welt größere epidemiologische Studien zur Häufigkeit psychischer Störungen in der Allgemeinbevölkerung durchgeführt worden, die auch eine grobe Abschätzung der Häufigkeit Sozialer Phobien erlauben. Ein Überblick über diese Studien ergibt allerdings auf den ersten Blick ein recht verwirrendes Bild, da die Prävalenzabschätzungen der verschiedenen Studien eine scheinbar widersprüchliche Befundlage erkennen lassen. Ältere - vor Einführung expliziter diagnostischer Kriterien für Soziale Phobi durchgeführte Studien aus den 60er und frühen 70er Jahren - schätzten die Prävalenz dieses Krankheitsbildes auf lediglich 1% (1). [...]"

BACKGROUND.One group of theories aiming at providing a framework explaining the etiology, maintenance and phenomenology of anxiety disorders is classified as cognitive models of anxiety. These approaches assume that distortions in specific levels of information processing are relevant for the onset and maintenance of the disorder. A detailed knowledge about the nature of these distortions would have important implications for the therapy of anxiety, as the implementation of confrontative or cognitive elements precisely fitting the distortions might enhance efficacy. Still, these models and related empirical evidence provide conflicting assumptions about the nature of disorder-linked processing distortions. Many cognitive models of anxiety (e.g., Fox, Russo, & Dutton, 2002; Mathews & Mackintosh, 1998; Williams, Watts, MacLeod, & Mathews, 1997) postulate that anxiety-linked biases of attention imply hypervigilance to threat and distractibility from other stimuli in the presence of feared materials. This is convincingly confirmed by various experimentalclinical studies assessing attention for threat in anxious participants compared to non-anxious controls (for a review, seeMathews &MacLeod, 2005). In contrast, assumptions concerning anxiety-linked biased memory for threat are less convincing; based on the shared tendency for avoidance of deeper elaboration in anxiety disorders, some models predict memory biases only for implicit memory tasks (Williams et al., 1997) or even disclaim the relevance of memory in anxiety at all (e.g., Mogg, Bradley, Miles, & Dixon, 2004). Other theories restrict the possibility of measuring disorder-specific memory biases to tasks that require merely perceptual encoding of the materials instead of verbal-conceptual memory (e.g., Fox et al., 2002; Mathews &Mackintosh, 1998). On the one hand, none of these models has integrated all the inconsistencies in empirical data on the topic. On the other hand, the numerous empirical studies on memory in anxiety that have been conducted with varying materials, anxiety disorders, encoding and retrieval conditions do not allow final conclusions about the prerequisites for finding memory biases (for a review, see MacLeod & Mathews, 2004). A more detailed investigation of the complete spectrum of memory for threat utilizing carefully controlled variations of depth of encoding and materials is needed. In view of these inconsistencies, it is all the more surprising that one important part of this spectrum has so far remained completely uninvestigated: visual working memory (VWM). No study has ever differentially addressed VWM for threat in anxious vs. nonanxious participants and none of the cognitive models of anxiety provides any predictions concerning this stage of information processing. Research on cognitive biases in anxiety has thus far only addressed the two extremes of the processing continuum: attention and longer-term memory. In between, a gap remains, the bridging of which might bring us closer to defining the prerequisites of memory biases in anxiety. As empirical research has provided substantial and coherent knowledge concerning attention in anxiety, and as attention and VWM are so closely linked (see, for instance, Cowan, 1995), the thorough investigation of VWM may provide important clues for models of anxiety. Is anxiety related to VWM biases favoring the processing of threatening information, or does the avoidance presumed by cognitive models of anxiety already begin at this stage? RESEARCH AIMS. To investigate the relevance of biased VWM in anxiety, the present research focused in eight experiments on the following main research questions: (1) Is threat preferably stored in VWM in anxious individuals? (2) Does threat preference occur at the cost of the storage of other items, or is extra storage capacity provided? (3) Would the appearance of threat interrupt ongoing encoding of non-threatening items? (4) Does prioritized encoding of threat in anxiety occur strategically or automatically? (5) Are disorder-specific VWM biases also materials-specific? (6) Are VWM biases in anxiety modifiable through cognitive-behavioral therapy? METHODS. In Experiments 1-4, a spatial-sequential cueing paradigm was used. A subset of real-object display items was successively cued on each trial by a sudden change of the picture background for 150 ms each. After the cueing, one of the display pictures was hidden and probed for a memory test. On most trials, a cued item was tested, and memory accuracy was determined depending on the item’s position within the cue string and depending on its valence. In some cases, memory for an uncued item was tested. Experiment 1 and 2 were directed at discovering whether spider fearfuls and non-anxious controls would differ with respect to the accuracy in memorizing cued spiders and uncued spiders and, thus, reveal disorder-specific biases of VWM. In addition, the question whether the presence of a spider image is related to costs for the memorization of other images was tested. Experiment 3 addressed whether any disorder-specific VWM biases found earlier were specific to the feared spiders. Therefore, the critical stimuli here were a snake and a spider. Participants were spider fearfuls and non-anxious controls, both without snake anxiety. In Experiment 4, it was tested whether disorder-specific biases found in Experiment 1 and 2 were modifiable through cognitive-behavioral treatment. The critical stimulus was a spider image. Spider fearfuls were tested three times. Half of them received a cognitive-behavioral intervention after the first test, the other half only after the second test. In two additional experiments, VWM was assessed with a change-detection paradigm. The main aim was to clarify whether disorder-specific effects found in the previous experiments were associated with automatic or with strategic selective encoding of threatening materials, and whether any group differences in spider change detection were materials-specific to spiders, but not to snakes. In Experiment 5, several images were presented simultaneously in a study display for either 100 or 500 milliseconds. After a short interruption, a test display was presented including either the same items as the first one or one changed item. Participants’ accuracy in determining whether displays were the same or different was measured depending on the valence of the changed item, set size, and presentation time of the display. There were trials with and without spiders. If a change was made, it could involve either a non-spider or a spider item. Of specific interest was the condition in which a spider image was presented initially, but not in the test phase, as noticing this specific change would require storage of that image in VWM. Would group differences be particularly pronounced in the shorter encoding condition suggesting automatic encoding of threat, or would they occur in the longer encoding condition, suggesting strategic encoding of spiders? In Experiment 6, change detection accuracy for spiders vs. snakes was tested. The participants in both experiments were spider fearfuls vs. controls, but those of Experiment 6 were additionally required to lack snake anxiety. Moreover, a temporal VWM paradigm - an attentional blink task - was applied to assess whether a biased encoding of spider images in spider fearfuls would occur at the expense of non-threatening items undergoing concurrent processing, and whether this effect was specific to spiders, but not to snakes. Series of real-object pictures were presented at rates of 80 ms at the display center. The observer’s task was to identify and report the two target pictures indicated by a brighter background. In Experiment 7, the first target always depicted a neutral item. The valence of the second target was varied - either negative depicting a spider, positive, or neutral. Participants varied with respect to their spider anxiety. In Experiment 8, spider fearfuls and non-anxious controls, both without snake anxiety, were tested. The experiment was nearly the same as the previous one, but two negative target types were tested: disorder-relevant spiders and negative but not feared snakes. Of specific interest was whether the appearance of a threatening target would reduce the report probability of the earlier attended target, indicating the interruption of its VWM encoding in favor of the threat item. RESULTS. (1) Both anxious and non-anxious controls, showed VWM advantages for negative materials such as spider or snake images. (2) In addition, there were disorderspecific VWM biases: some effects were larger in spider fearfuls than in non-anxious controls and some effects occurred exclusively in spider fearfuls. (3) Group differences and, thus, disorder-specificity were particularly pronounced under competitive circumstances, that is, under the condition of numerous stimuli competing for processing resources: when only little orientation time was allowed, when only little time was provided for selecting and encoding items from a crowd, and when VWMfor the critical item required reflexive instead of voluntary attention. (4) Pronounced memory for task-relevant, voluntarily attended spiders was related to difficulties in disengaging attention from these items in the fearful group, reflected in reduced memory accuracy for the item following it. (5) Disorder-specific VWM biases seem to be based on attentional biases to threatening materials resulting in a very quick, automatic memory consolidation. However, this preferential encoding was not at the cost of neutral materials currently undergoing encoding processes. (6) All disorder-specific VWM biases occured only with fear-related materials, not with other negative materials. (7) Automatic and highly disorder-specific fear-related VWM biases – but not strategic VWM biases occuring in both groups - were modifiable through cognitive-behavioral intervention. CONCLUSIONS. This work provides additional information about informationprocessing distortions related to specific anxiety. With the experimental investigation of biased VWM, this work has been performed to fill a gap within research on cognitive biases in anxiety. Moreover, this dissertation contributes to cognitive theories of anxiety by proposing several recommendations for refinements of current theoretical approaches. Most important, it was suggested to extend existing models by a more detailed consideration of attention and memory. In view of numerous previous empirical studies on the topic and the conclusions of this dissertation, a differentiation of the attentional engagement and disengagement component appears inevitable. Even more important, in view of the data presented here predictions concerning VWM for threatening materials need to be taken into account. In addition, suggestions are provided for the differential consideration of biases occuring from prepotent threat value of negative stimuli vs. individual threat value. A proposal for a cognitive model of anxiety extended by all these aspects is provided to serve as an invitation of further research in the investigation of the nature of memory biases in anxiety disorders. REFERENCES: Cowan, N. (1995). Attention and Memory. An integrated framework.New York: Oxford University Press. Fox, E., Russo, R., & Dutton, K. (2002). Attentional bias for threat: Evidence for delayed disengagement from emotional faces. Cognition and Emotion, 16, 355-379. MacLeod, C., & Mathews, A. (2004). Selective memory effects in anxiety disorders: An overview of research findings and their implications. In D. Reisberg & P. Hertel (eds.), Memory and Emotion. Oxford: Oxford University Press. Mathews, A., & Mackintosh, B. (1998). A cognitive model of selective processing in anxiety. Cognitive Therapy and Research, 22 (6), 539-560. Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1, 167-195.Mathews, Mogg, May, & Eysenck (1989). Mogg, K., Bradley, B.P., Miles, F., & Dixon, R. (2004). Time course of attentional bias for threat scenes: Testing the vigilance avoidance hypothesis. Cognition and Emotion, 18(5), 689-700. Williams, J.M.G., Watts, F.N., MacLeod, C., & Mathews, A. (1997). Cognitive psychology and emotional disorders. Chichester: John Wiley.

BACKGROUND.One group of theories aiming at providing a framework explaining the etiology, maintenance and phenomenology of anxiety disorders is classified as cognitive models of anxiety. These approaches assume that distortions in specific levels of information processing are relevant for the onset and maintenance of the disorder. A detailed knowledge about the nature of these distortions would have important implications for the therapy of anxiety, as the implementation of confrontative or cognitive elements precisely fitting the distortions might enhance efficacy. Still, these models and related empirical evidence provide conflicting assumptions about the nature of disorder-linked processing distortions. Many cognitive models of anxiety (e.g., Fox, Russo, & Dutton, 2002; Mathews & Mackintosh, 1998; Williams, Watts, MacLeod, & Mathews, 1997) postulate that anxiety-linked biases of attention imply hypervigilance to threat and distractibility from other stimuli in the presence of feared materials. This is convincingly confirmed by various experimentalclinical studies assessing attention for threat in anxious participants compared to non-anxious controls (for a review, seeMathews &MacLeod, 2005). In contrast, assumptions concerning anxiety-linked biased memory for threat are less convincing; based on the shared tendency for avoidance of deeper elaboration in anxiety disorders, some models predict memory biases only for implicit memory tasks (Williams et al., 1997) or even disclaim the relevance of memory in anxiety at all (e.g., Mogg, Bradley, Miles, & Dixon, 2004). Other theories restrict the possibility of measuring disorder-specific memory biases to tasks that require merely perceptual encoding of the materials instead of verbal-conceptual memory (e.g., Fox et al., 2002; Mathews &Mackintosh, 1998). On the one hand, none of these models has integrated all the inconsistencies in empirical data on the topic. On the other hand, the numerous empirical studies on memory in anxiety that have been conducted with varying materials, anxiety disorders, encoding and retrieval conditions do not allow final conclusions about the prerequisites for finding memory biases (for a review, see MacLeod & Mathews, 2004). A more detailed investigation of the complete spectrum of memory for threat utilizing carefully controlled variations of depth of encoding and materials is needed. In view of these inconsistencies, it is all the more surprising that one important part of this spectrum has so far remained completely uninvestigated: visual working memory (VWM). No study has ever differentially addressed VWM for threat in anxious vs. nonanxious participants and none of the cognitive models of anxiety provides any predictions concerning this stage of information processing. Research on cognitive biases in anxiety has thus far only addressed the two extremes of the processing continuum: attention and longer-term memory. In between, a gap remains, the bridging of which might bring us closer to defining the prerequisites of memory biases in anxiety. As empirical research has provided substantial and coherent knowledge concerning attention in anxiety, and as attention and VWM are so closely linked (see, for instance, Cowan, 1995), the thorough investigation of VWM may provide important clues for models of anxiety. Is anxiety related to VWM biases favoring the processing of threatening information, or does the avoidance presumed by cognitive models of anxiety already begin at this stage? RESEARCH AIMS. To investigate the relevance of biased VWM in anxiety, the present research focused in eight experiments on the following main research questions: (1) Is threat preferably stored in VWM in anxious individuals? (2) Does threat preference occur at the cost of the storage of other items, or is extra storage capacity provided? (3) Would the appearance of threat interrupt ongoing encoding of non-threatening items? (4) Does prioritized encoding of threat in anxiety occur strategically or automatically? (5) Are disorder-specific VWM biases also materials-specific? (6) Are VWM biases in anxiety modifiable through cognitive-behavioral therapy? METHODS. In Experiments 1-4, a spatial-sequential cueing paradigm was used. A subset of real-object display items was successively cued on each trial by a sudden change of the picture background for 150 ms each. After the cueing, one of the display pictures was hidden and probed for a memory test. On most trials, a cued item was tested, and memory accuracy was determined depending on the item’s position within the cue string and depending on its valence. In some cases, memory for an uncued item was tested. Experiment 1 and 2 were directed at discovering whether spider fearfuls and non-anxious controls would differ with respect to the accuracy in memorizing cued spiders and uncued spiders and, thus, reveal disorder-specific biases of VWM. In addition, the question whether the presence of a spider image is related to costs for the memorization of other images was tested. Experiment 3 addressed whether any disorder-specific VWM biases found earlier were specific to the feared spiders. Therefore, the critical stimuli here were a snake and a spider. Participants were spider fearfuls and non-anxious controls, both without snake anxiety. In Experiment 4, it was tested whether disorder-specific biases found in Experiment 1 and 2 were modifiable through cognitive-behavioral treatment. The critical stimulus was a spider image. Spider fearfuls were tested three times. Half of them received a cognitive-behavioral intervention after the first test, the other half only after the second test. In two additional experiments, VWM was assessed with a change-detection paradigm. The main aim was to clarify whether disorder-specific effects found in the previous experiments were associated with automatic or with strategic selective encoding of threatening materials, and whether any group differences in spider change detection were materials-specific to spiders, but not to snakes. In Experiment 5, several images were presented simultaneously in a study display for either 100 or 500 milliseconds. After a short interruption, a test display was presented including either the same items as the first one or one changed item. Participants’ accuracy in determining whether displays were the same or different was measured depending on the valence of the changed item, set size, and presentation time of the display. There were trials with and without spiders. If a change was made, it could involve either a non-spider or a spider item. Of specific interest was the condition in which a spider image was presented initially, but not in the test phase, as noticing this specific change would require storage of that image in VWM. Would group differences be particularly pronounced in the shorter encoding condition suggesting automatic encoding of threat, or would they occur in the longer encoding condition, suggesting strategic encoding of spiders? In Experiment 6, change detection accuracy for spiders vs. snakes was tested. The participants in both experiments were spider fearfuls vs. controls, but those of Experiment 6 were additionally required to lack snake anxiety. Moreover, a temporal VWM paradigm - an attentional blink task - was applied to assess whether a biased encoding of spider images in spider fearfuls would occur at the expense of non-threatening items undergoing concurrent processing, and whether this effect was specific to spiders, but not to snakes. Series of real-object pictures were presented at rates of 80 ms at the display center. The observer’s task was to identify and report the two target pictures indicated by a brighter background. In Experiment 7, the first target always depicted a neutral item. The valence of the second target was varied - either negative depicting a spider, positive, or neutral. Participants varied with respect to their spider anxiety. In Experiment 8, spider fearfuls and non-anxious controls, both without snake anxiety, were tested. The experiment was nearly the same as the previous one, but two negative target types were tested: disorder-relevant spiders and negative but not feared snakes. Of specific interest was whether the appearance of a threatening target would reduce the report probability of the earlier attended target, indicating the interruption of its VWM encoding in favor of the threat item. RESULTS. (1) Both anxious and non-anxious controls, showed VWM advantages for negative materials such as spider or snake images. (2) In addition, there were disorderspecific VWM biases: some effects were larger in spider fearfuls than in non-anxious controls and some effects occurred exclusively in spider fearfuls. (3) Group differences and, thus, disorder-specificity were particularly pronounced under competitive circumstances, that is, under the condition of numerous stimuli competing for processing resources: when only little orientation time was allowed, when only little time was provided for selecting and encoding items from a crowd, and when VWMfor the critical item required reflexive instead of voluntary attention. (4) Pronounced memory for task-relevant, voluntarily attended spiders was related to difficulties in disengaging attention from these items in the fearful group, reflected in reduced memory accuracy for the item following it. (5) Disorder-specific VWM biases seem to be based on attentional biases to threatening materials resulting in a very quick, automatic memory consolidation. However, this preferential encoding was not at the cost of neutral materials currently undergoing encoding processes. (6) All disorder-specific VWM biases occured only with fear-related materials, not with other negative materials. (7) Automatic and highly disorder-specific fear-related VWM biases – but not strategic VWM biases occuring in both groups - were modifiable through cognitive-behavioral intervention. CONCLUSIONS. This work provides additional information about informationprocessing distortions related to specific anxiety. With the experimental investigation of biased VWM, this work has been performed to fill a gap within research on cognitive biases in anxiety. Moreover, this dissertation contributes to cognitive theories of anxiety by proposing several recommendations for refinements of current theoretical approaches. Most important, it was suggested to extend existing models by a more detailed consideration of attention and memory. In view of numerous previous empirical studies on the topic and the conclusions of this dissertation, a differentiation of the attentional engagement and disengagement component appears inevitable. Even more important, in view of the data presented here predictions concerning VWM for threatening materials need to be taken into account. In addition, suggestions are provided for the differential consideration of biases occuring from prepotent threat value of negative stimuli vs. individual threat value. A proposal for a cognitive model of anxiety extended by all these aspects is provided to serve as an invitation of further research in the investigation of the nature of memory biases in anxiety disorders. REFERENCES: Cowan, N. (1995). Attention and Memory. An integrated framework.New York: Oxford University Press. Fox, E., Russo, R., & Dutton, K. (2002). Attentional bias for threat: Evidence for delayed disengagement from emotional faces. Cognition and Emotion, 16, 355-379. MacLeod, C., & Mathews, A. (2004). Selective memory effects in anxiety disorders: An overview of research findings and their implications. In D. Reisberg & P. Hertel (eds.), Memory and Emotion. Oxford: Oxford University Press. Mathews, A., & Mackintosh, B. (1998). A cognitive model of selective processing in anxiety. Cognitive Therapy and Research, 22 (6), 539-560. Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1, 167-195.Mathews, Mogg, May, & Eysenck (1989). Mogg, K., Bradley, B.P., Miles, F., & Dixon, R. (2004). Time course of attentional bias for threat scenes: Testing the vigilance avoidance hypothesis. Cognition and Emotion, 18(5), 689-700. Williams, J.M.G., Watts, F.N., MacLeod, C., & Mathews, A. (1997). Cognitive psychology and emotional disorders. Chichester: John Wiley.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Objectives: For characterizing the association between parenting and offspring social phobia (SP), contrasting maternal vs. paternal contributions, putative predictors of unfavorable parenting behaviors and its specificity for SP are warranted to delineate targeted prevention and intervention strategies. Methods: A population-based sample of 1053 adolescents was followed-up using the M-CIDI. Parenting was assessed via questionnaire in offspring passing the high risk period for SP-onset. Natal complications and childhood serious health problems as assessed by maternal reports were hypothesized to relate to unfavorable parenting. Results: The pattern of maternal overprotection, paternal rejection and lower emotional warmth was associated with SP, but not with other offspring anxiety disorders. Natal complications were related to overprotection and lower emotional warmth; trend-level associations emerged for serious health problems and unfavorable parenting. Conclusions: Paternal behavior appears particularly relevant for SP. The pattern of maternal overprotection, paternal rejection and lower emotional warmth was observed in SP only, suggesting that its detailed assessment provides a promising opportunity for targeted prevention and intervention in SP.

Le refus scolaire anxieux est un phénomène complexe et multiforme qui peut avoir des conséquences graves au niveau familial, professionnel et sur le fonctionnement psychique de l’adolescent. La reconnaissance précoce est importante car le pronostic dépend en partie de la rapidité de l’intervention. Cependant, le refus scolaire anxieux est un objet encore mal défini, ce qui entrave sa prise en charge et la reconnaissance du phénomène par l’ensemble des partenaires. A ce jour, il n’existe pas d’outil commun aux différents professionnels pour aider au repérage précoce. L’objectif général de cette recherche était de créer et de valider un auto-questionnaire de repérage du refus scolaire anxieux au collège. Trois études ont été menées successivement en utilisant une approche intégrative et une méthodologie mixte (qualitative pour l’étude 1 et quantitative pour les études 2 et 3). L’étude 1 a été l’occasion, à l’aide d’entretiens (N = 42), de recenser et d’organiser les différentes manifestations du refus scolaire anxieux au collège de façon à pouvoir créer ensuite les items du questionnaire. L’analyse de contenu a mis en évidence un modèle de description du refus scolaire en quatre grands thèmes. L’étude 2 (N = 22) a permis d’élaborer la version pilote du questionnaire (SChool REfusal EvaluatioN ; SCREEN). Cette étude portait sur les étapes de création et de sélection des items et sur la création de la structure du questionnaire. L’étude 3 (N = 584) a porté sur la validation de la SCREEN auprès de collégiens et de patients et la mise en évidence de scores seuils pour le repérage du refus scolaire anxieux. Les analyses factorielles indiquent que la SCREEN est composée de 18 items repartis en 4 facteurs. Une analyse en courbe ROC et une standardisation des résultats ont déterminé des scores seuils. Les résultats indiquent de bonnes qualités psychométriques de la SCREEN (sensibilité de .88 et spécificité de .89 ; alpha de Cronbach de .84). Le modèle issu de l’étude 1, ainsi que le questionnaire, peuvent être utilisés dans les établissements scolaires comme dans les services de soins, à des fins de recherche ou dans le cadre d’une pratique clinique. La SCREEN peut contribuer à l’orientation plus rapide des adolescents, aider au développement des études empiriques sur le refus scolaire anxieux et favoriser le travail de partenariat entre les différents acteurs. / Anxiety-based school refusal is a complex, ill-defined phenomenon related to several dimensions social, family, school, psychological…). This anxious absenteeism is a clinical reality with consequences on the adolescent’s family and professional perspectives and on his/her psychological functioning. As the prognosis depends to a large extent on early clinical care, early diagnosis is crucial. While a specific assessment is required, there is still no common tool that school professionals and health care professionals may use.The goal of this research was the creation and the validation of a self-reported screening tool for assessing school refusal.Three studies were carried out successively using an integrative approach and qualitative method (Study 1) or a quantitative method (Studies 2 and 3). The first study, with interviews (N = 42), aimed at a conceptual and operational definition of this construct. The content analysis revealed a descriptive model of school refusal comprising four different themes. The second study (N = 22) concerned the creation of the pilot version of the questionnaire (SChool REfusal EvaluatioN; SCREEN): generation of items, selection of items and creation of the questionnaire. The last study (n = 584) involved the validation of the SCREEN with a community sample of teenagers and a clinical sample. Analyses revealed a 4-factor model structure with 18 items. ROC analyses and standardization revealed a cut-off for screening school refusal. Results suggested that the tool has good psychometric properties (sensitivity .88; specificity .89; Cronbach’s alpha .84).The SCREEN and the descriptive model of school refusal can be helpful both at school and in health care services, for research and clinical practice. The SCREEN is useful for early clinical care, empirical studies, and for developing partnerships between school educators and health care professionals.

Die Spezifischen Phobien stellen die häufigste Gruppe der Angststörungen dar. Die Angst vor dem Verschlucken bzw. dem Ersticken wurde jedoch nur sehr selten beschrieben. Bei der Behandlung der Spezifischen Phobien wird fast immer eine Konfrontation in vivo eingesetzt. Die Angst vor dem Verschlucken scheint aber eine der Spezifischen Phobien zu sein, bei der eine Konfrontation schwierig ist. Die hier vorgestellte Fallgeschichte schildert eine mögliche Vorgehensweise, die Ängste vor dem Verschlucken mit einer Reizkonfrontation in vivo zu behandeln. Dabei werden die verschiedenen Schwierigkeiten, die aufgetreten sind, und ihre Lösungen geschildert. Die Therapie wurde erfolgreich abgeschlossen, und auch die Ergebnisse der Nachuntersuchungen zeigten eine stabile Verbesserung. / Specific phobias are the most common anxiety disorders. However, the fear of swallowing the wrong way and choking has rarely been described. Specific phobias are usually treated using exposure therapy. The excessive fear of swallowing the wrong way does not seem to be very well suited for an exposure in vivo. In this case study, a patient afflicted with the fear of swallowing and choking was treated with flooding. The various difficulties encountered during treatment and their remedies will be described. The therapy was successful. The patient showed stable and lasting improvements at posttreatment and at one-year follow-up. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Ce travail, inscrit dans une perspective psychanalytique propose, au travers de la clinique singulière de l'alcoolisme, une réflexion métapsychologique à propos de l'addiction, à l'appui d'un référentiel freudien et lacanien. Dans une attention particulière portée au triptyque sur lequel est fondée la métapsychologie, l'alcoolisme se voit alors abordé du point de vue économique augmenté des points de vue topique et dynamique, ouvrant ainsi autant de perspectives clinique que psychopathologique. Départi de toute conception déficitaire ou carentielle, c'est dans sa dimension conflictuelle qu'est appréhendé l'alcoolisme, hors du seul sillon narcissique. Au moyen d'une méthodologie croisée alliant cas cliniques issus de psychothérapie et cas cliniques de recherche enrichis des épreuves projectives, c'est au regard du sexuel que se trouve interrogé le symptôme alcoolique, privilégiant ainsi les problématiques œdipienne et de castration. A l'appui des concepts de répétition et de compulsion de répétition, il est dans un premier temps proposé de comprendre l'addiction en tant que conduite compulsive, aux fins de mettre en exergue la dynamique psychique sous-jacente au comportement et ce faisant, ses ressorts inconscient et fantasmatique. Figure d'un temps erratique, c'est dans ses incidences temporelles que l'addiction est mise en lumière, dans un différentiel entre cliniques de l'alcoolisme et de la toxicomanie. Si toutes deux procèdent à une subversion de la temporalité, que de la suspendre au seul profit de l'instant en vue de s'affranchir de toute causalité psychique, chacune relève d'une économie pulsionnelle propre. Si la conduite toxicomaniaque se montre massivement placée sous l'égide de Thanatos, l'alcoolisme n'en connaîtrait que de ponctuelles expressions, la dimension mortifère à l'œuvre dans la conduite alcoolique étant susceptible d'être imputée à Éros, de son excès d'intrication. Poursuivant, l'objet d'addiction, l'alcool, est questionné quant à sa fonction au sein de l'économie psychique du sujet. Envisagée comme tentative de solution de la part du sujet face à la castration et ses écueils, la conduite alcoolique se voit mise en lumière dans sa dimension de ratage, nommément phobique. L'objet d'addiction, alors entendu comme objet d'attraction, se fait le témoin du ratage de la constitution d'un objet phobique, répulsif par définition ; de cet échec, c'est alors la portée structurante de la phobie vis-à-vis de la castration qui disparaît, autant que le nouage de l'angoisse qu'elle offre - l'abstinence pouvant à ce titre être envisagée comme relance phobique. C'est à l'endroit de la figure paternelle et de ses défaillances que se poursuit la réflexion et, de la mise au jour de l'organisation œdipienne singulière qui en résulte, s'augure l'hypothèse d'un « complexe du père mort » chez ces hommes en proie à une conduite alcoolique. Enfin, le symptôme alcoolique se fait le lieu d'un débat psychopathologique entre névrose hystérique, fonctionnement limite et perversion. C'est l'hypothèse de l'hystérie masculine qui se verra défendue, la névrose se voyant ainsi abordée dans la gravité qu'elle peut recouvrir. C'est notamment des considérations quant au féminin, dans son opposition au phallique - et non au masculin - et à ce titre présent dans les deux sexes, que se soutiendra cette proposition. La question de la perte, très agissante dans les problématiques addictives, relue à la faveur du féminin, aboutit à un changement de paradigme, le narcissisme se trouvant relégué au second plan. / This work, part of a psychoanalytic perspective offers, through the singular clinical alcoholism, a metapsychological thinking about addiction, in support of a Freudian and Lacanian points of view. In a particular attention to the triptych on which is founded metapsychology, alcohol will be addressed through an economic point of view, increased with topographical and dynamic points of view, opening many as clinical and psychopathological perspectives. Divested of any deficit or carentiel design is in its conflictual dimension that will be apprehended alcoholism outside the narcissistic single way. Using a cross methodology combining cases from clinical psychotherapy and research, enriched projective tests is that in terms of psychosexuality is found interrogated alcoholic symptoms, and favoring Oedipal issues and castration. In support of the concepts of repetition and compulsion to repeat, it will be initially offered to understand addiction as compulsive behavior, in order to highlight the psychological dynamics underlying the behavior and thereby its unconscious and fantasmatic motivations. Figure of an erratic time, it is in its temporal effects that addiction will be found highlighted in a clinical difference between alcoholism and drugaddiction. If both proceed to a subversion of temporality in suspending it, in favour of instant, in order to overcome any psychical causality, each has is own instinctual economy. If drugaddiction shows heavily under the aegis of Thanatos, alcoholism would know only occasional expressions of the death instinct; mostly morbid dimension in alcoholaddiction may be attributed to Eros, because of its excessive fusion. Continuing, the object of addiction, alcohol, will be questioned as to its function within the psychic economy of the subject. Considered as attempted solution from the subject facing castration and its pitfalls, alcoholic behavior will be highlighted in its dimension of misfires, namely phobic. The object of addiction, then heard as an object of attraction, would witness misfires of the establishment of a phobic object, repulsive by definition. Through this failure, the structuring significance of phobia regarding castration disappears, as far as the knotting anxiety it offers - abstinence as such can be considered as phobic relaunch . This reflection will continue regarding the father figure and its failures and by means of the discovery of the singular oedipal organization that results, will herald the hypothesis of a "dead father complex" in these alcoholic's men. Finally, the alcoholic symptom will be the site of a psychopathological debate between hysterical neurosis, perversion and borderline. This is the hypothesis of male hysteria that will be defended, neurosis addressed in seeing the seriousness it can cover. This is particularly the considerations about the feminine, in its opposition to the phallic and not to masculine - and for that reason, present in both sexes, that will support this proposal, to authorize a re-reading of the issue of loss, very active in addictive problems, in a paradigm shift, narcissism being upstaged.

Objectives: For characterizing the association between parenting and offspring social phobia (SP), contrasting maternal vs. paternal contributions, putative predictors of unfavorable parenting behaviors and its specificity for SP are warranted to delineate targeted prevention and intervention strategies. Methods: A population-based sample of 1053 adolescents was followed-up using the M-CIDI. Parenting was assessed via questionnaire in offspring passing the high risk period for SP-onset. Natal complications and childhood serious health problems as assessed by maternal reports were hypothesized to relate to unfavorable parenting. Results: The pattern of maternal overprotection, paternal rejection and lower emotional warmth was associated with SP, but not with other offspring anxiety disorders. Natal complications were related to overprotection and lower emotional warmth; trend-level associations emerged for serious health problems and unfavorable parenting. Conclusions: Paternal behavior appears particularly relevant for SP. The pattern of maternal overprotection, paternal rejection and lower emotional warmth was observed in SP only, suggesting that its detailed assessment provides a promising opportunity for targeted prevention and intervention in SP.