Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 7 G Persönlichkeitsstörungen, F6 // Personality disorders F6
Störung und deuten daraufhin, dass sowohl eine genetische Vulnerabilität
(z. B. Temperament) als auch belastende Umweltfaktoren
(z. B. maladaptiver Erziehungsstil) an der Entwicklung der BPS beteiligt
sind. Allerdings weisen viele dieser Untersuchungen erhebliche
methodische Mängel auf (z. B. Querschnittanalysen, retrospektive
Erhebungen). Ziel der vorliegenden Untersuchung war es
durch eine verbesserte Methodik ein erweitertes Verständnis von
der Entwicklung der BPS zu erhalten.
Methode: Auf der Basis prospektiver längsschnittlicher Daten aus
einer nicht-klinischen Familienstudie wurde die familiäre Aggregation
der BPS bei Nachkommen von BPS-Müttern direkt untersucht
und Prädiktoren der Störung identifiziert.
Diskussion / Ergebnisse: Der Vergleich zu gesunden und klinischen
Kontrollgruppen zeigte ein deutlich gehäuftes Auftreten der
BPS bei Nachkommen von BPS-Müttern. Personen mit einer BPS
wiesen fünf Jahre vor der Diagnose stärkere emotionale und behaviorale
Probleme, ein ängstlicheres Temperament auf und nahmen
den Erziehungsstil ihrer Mütter als negativer wahr im Vergleich zu
Gesunden und depressiven Personen. Als Prädiktoren einer BPS
Diagnose erwiesen sich emotionale Probleme während der Adoleszenz.
Außerdem zeigte ein Interaktionseffekt, dass ein maladaptiver
Erziehungsstil der Mutter das BPS-Risiko der Nachkommen
erhöhen kann, allerdings nur wenn die Nachkommen ein eher
ängstlich-vermeidendes Temperament aufweisen.
Freitag, 27. 11. 2009, 15.30 – 17.00 Uhr, Saal Prag
BS-016 Symposium
Research in personality disorders
(In cooperation with the Vlaamse Vereniging voor Psychiatrie)
Vorsitz: G. Pieters (Zemst, Belgien), P. Haake (Kortenberg, Belgien)
001
Overgeneral Memory in Borderline Personality Disorders
Kris Van den Broeck (UPC K.U. Leuven, Campus Kortenberg, Belgien)
L. Claes, G. Pieters, F. Raes
Overgeneral memory has been observed in traumatized and (previously)
depressed patients, and correlates with poor problem solving
skills, rumination, less non-suicidal self-injury, poor treatment outcome
and an avoidant style towards events, thoughts and emotions.
A limited number of research teams examined autobiographical
memory specificity in patients diagnosed with borderline personality
disorder. Since these patients often complain about mood instability
and often experienced trauma(s) in their youth, a replication
of the overgeneral memory bias was expected. However, evidence
was not univocal. Our ongoing line of research tries to test four
hypotheses on why the evidence found so far is scattered. We will
present our research project, its background and some preliminary
results, as well as implications for treatment.
002
Comparison of borderline patients with and without non-suicidal
self-injury
Laurence Claes (Catholic University, Faculty of Psychology, Leuven)
P. Haake, F. Raes, K. Van den Broeck, G. Pieters
Introduction: Non-suicidal self-injury (NSSI) refers to direct and
deliberate damage to one‘s own body tissue without suicidal intent.
NSSI occurs in 70 – 80 % of patients who meet DSM-IV criteria for
borderline personality disorder (BPD). In the present study, we investigated
trauma, psychopathology and avoidance coping in BPD
patients „without NSSI“, „with one type of NSSI“ (e. g., cutting) and
„with two or more types of NSSI” (e. g., cutting, burning, biting).
Further, NSSI characteristics were compared between patients
„with one type“ or „more than one type“ of NSSI.
Method: We collected data of 54 patients admitted to a specialized
treatment unit for BPD in a university psychiatric hospital in Belgium.
Overall, 75.9 % of the BPD patients admitted NSSI during
life-time, of whom 27.8 % displayed one type of NSSI and 48.1 %
more than one type of NSSI.
Discussion / Results: The results clearly show a gradual in crease in
trauma, psychopathology (depression, suicidal ideation, dissociation)
and avoidance coping, with an increasing number of NSSI.
Further, mediation analyses suggest that avoidance coping mediates
the relationship between trauma and NSSI; confirming the affect-regulation
function of NSSI. Finally, patients with more types
of NSSI show different NSSI characteristics than patients with only
one type of NSSI (e. g., more frequently NSSI / per day, less pain
sensitivity, less wound care). Conclusion: The presence of different
types of NSSI in BPD seems to be an indicator of the severity of
psychopathology. Clinical implications of these findings will be discussed.
003
The operationalization and assessment of process variables in
psychodynamic oriented process-outcome research on personality
disordered patients
Benedicte Lowijk
R. Vermote
Introduction: A growing body of outcome studies supports the efficacy
and effectiveness of psychodynamic treatment in treating
PDs (e. g., Chiesa and Fonagy, 2007). Yet, little is known about the
underlying processes explaining this outcome (e. g., Kazdin, 2007).
As has been recently emphasized, the understanding of this process
and investigating the relationship between process and outcome is
however by no means a trivial matter (Fonagy and Bateman, 2006;
Levy, 2008).
Method: This presentation will focus on the operationalization,
conceptualization and assessment of process variables characteristic
for psychodynamic psychotherapy of PDs, with the main focus
on the concept of personality structure or organization (PO).
Discussion / Results: First, operationalizations from different psychodynamic
perspectives and various assessment tools (ranging
from interview, projective and Q-sort methods to self-report methods)
developed to measure PO will be discussed (e. g., Clarkin,
Caligor, Stern, & Kernberg, 2007; Diamond, Blatt, Stayner, &
Kaslow, 1991). Second the implications of the operationalization
and assessment of PO for research on PDs, and for psychodynamic
process-outcome research in particular will be discussed.
References Chiesa, M., & Fonagy, P. (2007). Prediction of mediumterm
outcome in cluster B personality disorder following residential
and outpatient psychosocial treatment. Psychotheraoy and Psychosomatics,
76, 347-353. Diamond, D., Blatt, S. J., Stayner, D., &
Kaslow, N. (1992). Self-other differentiation of object representations.
Yale University, USA: Unpublished research manual. Fonagy,
P., & Bateman, A. (2006) Progress in treatment of borderline personality
disorder. British Journal of Psychiatry, 188, 1-3. Kazdin, A. E.
(2007). Mediators and mechanism of change in psychotherapy research.
Annual Review of Clinical Psychology, 3, 1-7. Levy K. N.
(2008). Psychotherapies and lasting change. American Journal of
Psychiatry, 165: 556-559.
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