According to current concepts of functional psychosomatic disorders, disturbed interoceptive processes are considered relevant causal factors especially in relation to panic disorders and functional cardiac complaints. In our study, heart beat perception was assessed for subgroups of psychosomatic disorders and in comparison to healthy controls. A further issue was the distribution of performance scores across diagnostic subgroups. Special consideration was given to the question of panic patients forming two extreme groups with either better or worse perception than other patient groups. Additionally, a subsample of patients was tested twice in order to establish test-retest-reliability of heart beat perception. Within the whole group of 546 patients, marginally significant differences in heart beat perception scores in the Schandry Mental Tracking Task between subgroups became evident. The detection score of patients with personality disorders was lower compared to patients with functional disorders and healthy controls. Patients with functional heart disorder and panic patients did not have higher perception scores than controls. Effects of medication were taken into account. Only medicated panic patients showed better heart beat perception than unmedicated ones. The distribution of heart beat perception was similar in all groups studied, patients with panic disorders did not differ from the general picture. Time stability after a 4 week interval in 42 patients was sufficiently high to show trait characteristics reaching r = .58. In general, psychosomatic patients are characterized by a tendency towards lower perception scores compared to healthy subjects. Better than normal interoceptive functioning, in contrast to some literature reports, does not seem to play a decisive role in the establishment of functional psychosomatic disorders.

Patients with diabetes mellitus (DM) often have alterations of the autonomic nervous system (ANS), even early in their disease course. Previous research has not evaluated whether these changes may have consequences on adaptation mechanisms in DM, e.g. to mental stress. We therefore evaluated whether patients with DM who already had early alterations of the ANS reacted with an abnormal regulatory pattern to mental stress. We used the spectral analysis technique, known to be valuable and reliable in the investigation of disturbances of the ANS. We investigated 34 patients with DM without clinical evidence of ANS dysfunction (e.g. orthostatic hypotension) and 44 normal control subjects (NC group). No patients on medication known to alter ANS responses were accepted. The investigation consisted of a resting state evaluation and a mental stress task (BonnDet). In basal values, only the 21 patients with type 2 DM were different in respect to body mass index and systolic blood pressure. In the study parameters we found significantly lower values in resting and mental stress spectral power of mid-frequency band (known to represent predominantly sympathetic influences) and of high-frequency and respiration bands (known to represent parasympathetic influences) in patients with DM (types 1 and 2) compared with NC group (5.3 +/- 1.2 ms2 vs. 6.1 +/- 1.3 ms2, and 5.5 +/- 1.6 ms2 vs. 6.2 +/- 1.5 ms2, and 4.6 +/- 1.7 ms2 vs. 6.2 +/- 1.5 ms2, for resting values respectively; 4.7 +/- 1.4 ms2 vs. 5.9 +/- 1.2 ms2, and 4.6 +/- 1.9 ms2 vs. 5.6 +/- 1.7 ms2, and 3.7 +/- 2.1 ms2 vs. 5.6 +/- 1.7 ms2, for stress values respectively; M/F ratio 6/26 vs. 30/14). These differences remained significant even when controlled for age, sex, and body weight. However, patients with DM type 2 (and significantly higher body weight) showed only significant values in mental stress modulus values. There were no specific group effects in the patients with DM in adaptation mechanisms to mental stress compared with the NC group. These findings demonstrate that power spectral examinations at rest are sufficiently reliable to diagnose early alterations in ANS in patients with DM. The spectral analysis technique is sensitive and reliable in investigation of ANS in patients with DM without clinically symptomatic autonomic dysfunction.

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