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Themenschwerpunkt

Psychotherapie von Patienten mit Borderline Persönlichkeitsstörung und Abhängigkeitserkrankung

Published Online:October 12, 2011https://doi.org/10.1024/0939-5911.a000139

Abstract

Hintergrund: Viele Patienten mit einer Borderline Persönlichkeitsstörung (BPS) haben zudem eine Abhängigkeitserkrankung. Die psychotherapeutische Behandlung von Patienten mit Persönlichkeitsstörung und einer komorbid bestehenden Abhängigkeitserkrankung ist eine Herausforderung für das behandelnde Team. Sie erfordert ein integriertes Vorgehen, das zeitgleich die Therapie beider Störungen gewährleistet. Methodik: Eine systematische Literaturrecherche wurde bei den Datenbanken PubMed, PsychINFO, PsycArticles und Medline durchgeführt. Zusätzliche Artikel wurden über Referenzen in Reviews und empirische Studien hinzugezogen. Ergebnisse: Obwohl viele Studien die Wirksamkeit von Psychotherapie bei Persönlichkeitsstörungen belegt haben, gibt es nur wenige Studien, bei denen die Interferenz durch eine komorbide Suchterkrankung mit in der Untersuchung berücksichtigt worden ist. Die Literaturrecherche ergab 8 klinische Effektivitätsstudien zur Psychotherapie von BPS mit komorbider Abhängigkeitserkrankung. Bisher stehen für die Behandlung dieser Komorbidität zwei evaluierte integrierte Therapieverfahren zur Verfügung: die Dual-Fokus-Schema-Therapie und die Dialektisch-Behaviorale-Therapie-Sucht. Schlussfolgerungen: Beide Therapieformen scheinen effektiv bei der Reduzierung des Substanzmissbrauchs und der psychopathologischen Symptome der BPS zu sein. Es besteht keine nachgewiesene Überlegenheit eines der beiden Therapieverfahren. Der Vorteil der DBT-S liegt in stringenten Therapeutentrainings und einer guten Vermittelbarkeit des Konzepts sowohl für das Team als auch für die Patienten. Es bedarf allerdings weiterer Studien zur Überprüfung der Effektivität.


Psychotherapy for Patients with Borderline Personality Disorder and Comorbid Addiction Disorder

Background: Many patients with borderline personality disorder (BPD) do have a comorbid addiction disorder. Psychotherapy for patients with personality disorder and addiction is a challenging task for the therapeutic team, and requires if possible an integrative approach. Methods: A systematic literature research using PubMed, PsychINFO, PsycArticles, and Medline was conducted. Additional articles were considered which were mentioned in reviews and empirical studies. Results: Although many studies have shown the effectiveness of psychotherapy treating personality disorders, only few studies took co-morbid addiction into account. The literature research showed eight clinical trials that investigated the effectiveness of psychotherapy for BPD and addiction. To date, there are only two integrated psychotherapeutic methods that claim to be effective on an evidence based level to treat personality disorder and addiction simultaneously: the dual focus schema therapy (DFST) and the dialectic behavioural therapy addiction (DBT-S). Conclusions: Both intervention programs seem to be effective in reducing substance use and psychopathological symptoms of BPD. There is no evidence for superiority of one psychotherapeutic intervention program for BPD and co-morbid addiction. The advantage of the DBT-S is a unitized concept for training therapists and an easily understandable concept for the team as well as for the patient. Further studies are needed to prove the effectiveness.

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