Zusammenfassung
Anliegen Ziel der Studie war es, die Ausprägung des Sense of Coherence (SOC) und den Zusammenhang
zwischen SOC, Ängstlichkeit, Depressivität, somatoformen Beschwerden und Lebenszufriedenheit
bei Bulimia nervosa (BN) zu untersuchen. Methode In einer Querschnittsstudie wurden 73 ambulante BN-Patientinnen mit der Sense of
Coherence Scale (SOC-13), der Hospital Anxiety and Depression Scale (HADS-D) und dem
Screening für Somatoforme Störungen (SOMS-2) untersucht. Ergebnisse Die BN-Patientinnen zeigten im Vergleich zur Normgruppe ein extrem geringes Kohärenzgefühl
(M = 45,09 vs. M = 71,23; p ≤ 0,001). Das Kohärenzgefühl korrelierte signifikant negativ
mit der Depressivität und der Anzahl der somatoformen Symptome. Dagegen fand sich
ein signifikant positiver Zusammenhang mit der Lebenszufriedenheit (r = 0,467; p ≤ 0,001).
Zwischen SOC und Ängstlichkeit bestand kein Zusammenhang. Schlussfolgerungen Die Ergebnisse stützen die Hypothese, dass ambulante BN-Patientinnen hinsichtlich
ihrer depressiven Symptomatik und der somatoformen Beschwerden von einer gezielten
Stärkung des Kohärenzgefühls profitieren könnten.
Abstract
Objective The aim of the current study was to examine the occurrence of sense of coherence
(SOC) and the relationship between SOC and anxiety, depression, somatoform complaints
and life satisfaction in female bulimia nervosa (BN) outpatients. Methods In a consecutive cross-sectional study 73 BN outpatients (age 26.9 years, SD 7.8)
were assesssed with the Sense of Coherence Scale (SOC-13), the Hospital Anxiety and
Depression Scale (HADS-D), and the Screening for Somatoform Disorders (SOMS-2). Results The BN outpatients showed highly reduced SOC in comparison to the reference group
(M = 45.09 vs. M = 71.23; p ≤ 0.001). SOC significantly correlated inversely with
depression and somatoform complaints. Additionally, there was a positive correlation
between SOC and life satisfaction (r = 0.467; p ≤ 0.001). Interestingly, SOC was not
significantly correlated with anxiety. Conclusions The results support the thesis that female BN outpatients could benefit from an enhancement
of SOC particularly with regard to depression and somatoform complaints.
Schlüsselwörter
Sense of Coherence - Bulimia nervosa - Depression - Ängstlichkeit - Somatisierung
Key words
sense of coherence - bulimia nervosa - depression - anxiety - somatization
Literatur
1
Hoek H W, van Hoeken D.
Review of the prevalence and incidence of eating disorders.
Int J Eat Disord.
2003;
34
383-396
2
Hach I, Ruhl U E, Rentsch A. et al .
Recognition and therapy of eating disorders in young women in primary care.
J Public Health.
2005;
13
160-165
3
Keel P K, Heatherton T F, Dorer D J. et al .
Point prevalence of bulimia nervosa in 1982, 1992, and 2002.
Psychol Med.
2006;
36
119-127
4
Currin L, Schmidt U, Treasure J, Jick H.
Time trends in eating disorder incidence.
Br J Psychiatry.
2005;
186
132-135
5
van Son G E, van Hoeken D, Bartelds A IM. et al .
Time trends in the incidence of eating disorders: a primary care study in the Netherlands.
Int J Eat Disord.
2006;
39
565-569
6
Johnson J G, Spitzer R L, Williams J BW.
Health problems, impairment and illnesses associated with bulimia nervosa and binge
eating disorder among primary care and obstetric gynaecology patients.
Psychol Med.
2001;
31
1455-1466
7
Grissett N I, Norvell N K.
Perceived social support, social skills, and quality of relationships in bulimic women.
J Consult Clin Psychol.
1992;
60
293-299
8
Tiller J M, Sloane G, Schmidt U. et al .
Social support in patients with anorexia nervosa and bulimia nervosa.
Int J Eat Disord.
1997;
21 (1)
31-38
9
Rorty M, Yager J, Buckwalter J G, Rossotto E.
Social support, social adjustment, and recovery status in bulimia nervosa.
Int J Eat Disord.
1999;
26
1-12
10
Schneider J A, O'Leary A, Agras W S.
The role of perceived self-efficacy in recovery from bulimia: a preliminary examination.
Behav Res Ther.
1987;
25
429-432
11
Dalgleish T, Tchanturia K, Serpell L. et al .
Perceived control over events in the world in patients with eating disorders: a preliminary
study.
Pers Individ Dif.
2001;
31
453-460
12
Berman E S.
The relationship between eating self-efficacy and eating disorder symptoms in a non-clinical
sample.
Eating Behaviors.
2006;
7
79-90
13
Antonovsky A.
The structure and properties of the sense of coherence scale.
Soc Sci Med.
1993;
36
725-733
14
Sagy S, Antonovsky H.
The development of the sense of coherence: a retrospective study of early life experiences
in the family.
J Aging and Human Development.
2000;
51
155-168
15
Heim E.
Salutogenese versus Pathogenese – ein neuer Zugang zu einer alten Weisheit.
Schweiz Med Wochenschr.
1994;
124
1267-1275
16
Nagel G.
Salutogenese.
Praxis.
2000;
89
356-359
17
Schnyder U, Büchi S, Mörgeli H. et al .
Sense of coherence – A mediator between disability and handicap?.
Psychother Psychosom.
1999;
68
102-110
18
Suominen S, Helenius H, Blomberg H. et al .
Sense of coherence as a predictor of subjective state of health: results of 4 years
of follow-up of adults.
J Psychosom Res.
2001;
50
77-86
19
Eriksson M, Lindström B.
Antonovsky's sense of coherence scale and the relation with health: a systematic review.
J Epidemiol Community Health.
2006;
60
376-381
20
Tagay S, Senf W, Schopper N. et al .
Protective factors for anxiety and depression in thyroid cancer patients.
Psychosom Med Psychother.
2007;
53
62-74
21
Tagay S, Herpertz S, Langkafel M, Senf W.
Posttraumatic stress disorder in a psychosomatic outpatient clinic. Gender effects,
psychosocial functioning, sense of coherence, and service utilization.
J Psychosom Res.
2005;
58
439-446
22
Tagay S, Erim Y, Brähler E, Senf W.
Religiosity and sense of coherence – Protective factors of mental health and well-being?.
Med Psychol.
2006;
4
165-171
23
Schumacher J, Wilz G, Gunzelmann T, Brähler E.
The sense of coherence scale of Antonovsky.
Z Psychosom Med Psychother.
2000;
50
472-482
24
Hannöver W, Michael A, Meyer C. et al .
Die Sense of coherence scale von Antonovsky und das Vorliegen einer psychiatrischen
Diagnose.
Psychother Psych Med.
2004;
54
179-186
25 Egle U T, Hoffmann S O, Lehmann K, Nix W A Hrsg. Handbuch Chronischer Schmerz. Stuttgart;
Schattauer 2002
26
Fichter M M.
Anorexic and bulimic eating disorders.
Nervenarzt.
2005;
76
1141-1152
27 Dilling H, Mombour W, Schmidt M H. Internationale Klassifikation psychischer Störungen,
ICD-10. Bern, Göttingen, Toronto; Verlag Hans Huber 1991
28 Bengel J, Strittmatter R, Willmann H. Was erhält Menschen gesund? Antonovkys Modell
der Salutogenese – Diskussionsstand und Stellenwert. Köln; Bundeszentrale für gesundheitliche
Aufklärung 1999
29
Zigmond A S, Snaith R P.
The hospital anxiety and depression scale.
Acta Psychiatr Scand.
1983;
67
361-370
30
Herrmann C.
International Experiences with the Hospital Anxiety and Depression Scale – A review
of validation data and clinical results.
J Psychosom Res.
1997;
42
17-41
31 Rief W, Hiller W, Heuser J. SOMS – Das Screening für Somatoforme Störungen. Manual
zum Fragebogen. Bern; Hans Huber 1997
32
Tagay S, Herpertz S, Langkafel M, Senf W.
Trauma, posttraumatische Belastungsstörung und Somatisierung.
Psychother Psychosom Med Psychol.
2004;
54
198-205
33
Nilsson B, Holmgren L, Stegmayr B, Westman G.
Sense of coherence – stability over time and relation to health, disease, and psychosocial
changes in an general population: A longitudinal study.
Scand J Public Health.
2003;
31
297-304
34
Flensborg-Madsen T, Ventegodt S, Merrick J.
Why is Antonovsky's sense of coherence not correlated to physical health? Analysing
Antonovsly's 29-item sense of coherence scale (SOC-29).
Scientific World Journal.
2005;
5
767-776
35
Lindström B, Eriksson M.
Salutogenesis.
J Epidemiol Community Health.
2005;
59
440-442
36
Porcelli P, Leandro G, De Carne M.
Functional Gastrointestinal Disorders and Eating Disorders.
Scan J Gastroenterol.
1998;
33
577-582
37
Boyd C, Abraham S, Kellow J.
Psychological Features are Important Predictors of Functional Gastrointestinal Disorders
in Patients with Eating Disorders.
Scandinavian Journal of Gastroenterology.
2005;
40
929-935
38 Grawe K. Neuropsychotherapie. Göttingen; Hogrefe 2004
39 Bandura A. Social Learning Theory. Englewood Cliffs, NJ; Prentice Hall 1977
40
Fairburn C G, Cooper Z, Shafran R.
Cognitive behavior therapy for eating disorders: a „trandiagnostic” theory and treatment.
Behav Res Ther.
2003;
42
509-528
Dr. rer. medic. Dipl.-Psych. Sefik Tagay
Rheinische Kliniken Essen, Klinik für Psychosomatische Medizin und Psychotherapie,
Universität Duisburg-Essen
Virchowstraße 174
45147 Essen
eMail: sefik.tagay@uni-due.de