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Suchttherapie 2022; 23(04): 170-176
DOI: 10.1055/a-1937-6677
Schwerpunktthema

Persönlichkeitsstörungen und Sucht

Personality Disorder and Addiction
Marc Walter
1   Psychiatrische Dienste Aargau AG (PDAG), Windisch, Schweiz
,
Eva-Maria Pichler
1   Psychiatrische Dienste Aargau AG (PDAG), Windisch, Schweiz
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Zusammenfassung

In der Klinik kommen Suchterkrankungen bei Patient:innen mit Persönlichkeitsstörungen häufig vor. Bei etwa jeder zweiten Persönlichkeitsstörung kann eine komorbide Suchterkrankung diagnostiziert werden. Bei Patient:innen mit einer Drogenabhängigkeit scheint eine komorbide Persönlichkeitsstörung etwas häufiger als bei der Alkoholabhängigkeit aufzutreten. Eine besonders häufige Assoziation wurde zwischen Cluster-B-Persönlichkeitsstörungen (DSM-5) und einer komorbiden Suchterkrankung gefunden.

In der Behandlung der Komorbidität sollte der Grundsatz gelten, dass beide Störungsbilder beachtet und gemeinsam behandelt werden. Ist die Persönlichkeitsproblematik im Vordergrund, werden insbesondere störungsspezifische Psychotherapien mit Erfolg angewandt (z. B. Dialektisch-Behaviorale Therapie DBT, Übertragungsfokussierte Therapie TFP, Mentalisierungsbasierte Therapie MBT, Schematherapie). Ist die Suchtproblematik klinisch führend, kommen derzeit neben pharmakologischen Behandlungen vorrangig suchtspezifische Interventionen, wie die Motivierende Gesprächsführung oder die Rückfallprävention zum Einsatz. Bei evidenzbasierter Behandlung ist die Prognose wahrscheinlich günstiger als dies in Studien bisher berichtet wurde.

Abstract

Addictive disorders are common in patients with personality disorders. In about every second personality disorder, a comorbid substance use disorder can also be diagnosed. In patients with drug addiction, comorbid personality disorder seems to occur more frequently than in alcohol addiction. A particularly frequent association was found between Cluster-B personality disorder and a comorbid addictive disorder.

In the treatment of comorbidity, the principle should be that both disorders are considered and treated together. If the personality disorder is prominent, disorder-specific psychotherapies can be used successfully (e. g. Dialectical Behavior Therapy DBT, Transference-focused Psychotherapy TFP, Mentalization-Based-Treatment MBT, schema therapy). If the substance use disorder is dominant, addiction-specific interventions, such as motivational interviewing or relapse prevention, are to be used in addition to pharmacological treatments.

With evidence-based treatment, the prognosis is likely to be more favorable than has been reported in earlier studies.

Schlüsselwörter

Suchterkrankungen - Persönlichkeitsstörungen - Komorbidität - Behandlung

Key words

substance use disorder - personality disorder - comorbidity - treatment


Publication History

Article published online:
26 September 2022

© 2022. Thieme. All rights reserved.

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  • Literatur

  • 1 Dilling H, Mombour W, Schmidt MH. (1991) Internationale Klassifikation psychischer Störungen: ICD-10, Kapitel V (F). Klinisch-diagnostische Leitlinien, Weltgesundheitsorganisation. Bern: Huber; 1991
    Google Scholar
  • 2 Herpertz SC. Neue Wege in der Klassifikation von Persönlichkeitsstörungen in ICD-11. Fortschr Neurol Psychiatr 2018; 86: 150-155
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington: American Psychiatric Publishing; 2013
    Google Scholar
  • 4 Fiedler P. Persönlichkeitsstörungen. 6. Aufl. Weinheim: Beltz Psychologie Verlags-Union; 2007
    Google Scholar
  • 5 Coid J, Yang M, Tyrer P. et al. (2006) Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 2006; 188: 423-431
    CrossrefPubMedGoogle Scholar
  • 6 Walter M, Bilke-Hentsch O. Narzissmus. Grundlagen – Formen – Interventionen. Stuttgart: Kohlhammer; 2020
    CrossrefGoogle Scholar
  • 7 Herpertz SC, Zanarini M, Schulz CS. et al. WFSBP Task Force on Personality Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders. World J Biol Psychiatry 2007; 8: 212-44
    CrossrefPubMedGoogle Scholar
  • 8 Narayan VM, Narr KL, Kumari V. et al. Regional cortical thinning in subjects with violent antisocial personality disorder or schizophrenia. Am J Psychiatry 2007; 164: 1418-1427
    CrossrefPubMedGoogle Scholar
  • 9 Dammann G, Hügli C, Selinger J. et al. The self-image in patients with borderline personality disorder. J Pers Disord 2011; 25: 517-527
    CrossrefPubMedGoogle Scholar
  • 10 Gunderson JG. Borderline personality disorder. N Engl J Med 2011; 364: 2037-2042
    CrossrefPubMedGoogle Scholar
  • 11 Trull TJ, Jahng S, Tomko RL. et al. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord 2010; 24: 412-426
    CrossrefPubMedGoogle Scholar
  • 12 Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry 2005; 162: 1911-1918
    CrossrefPubMedGoogle Scholar
  • 13 Gunderson JG. Borderline Personality Disorder: Ontogeny of a Diagnosis. Am J Psychiatry 2009; 166: 530-539
    CrossrefPubMedGoogle Scholar
  • 14 Zadra S, Bischof G, Besser B. et al. The association between internet addiction and personality disorders in a general population-based sample. J Behav Addict 2016; 5: 691-699
    CrossrefPubMedGoogle Scholar
  • 15 Hasin D, Fenton MC, Skodol A. et al. Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. Arch Gen Psychiatry 2011; 68: 1158-1167
    CrossrefPubMedGoogle Scholar
  • 16 Preuss UW, Johann M, Fehr C. et al. Personality disorders in alcohol-dependent individuals: relationship with alcohol dependence severity. Eur Addict Res 2009; 15: 188-195
    CrossrefPubMedGoogle Scholar
  • 17 Newton-Howes G, Foulds J. Personality Disorder and Alcohol Use Disorder: An Overview. Psychopathology 2018; 51: 130-136
    CrossrefPubMedGoogle Scholar
  • 18 Verheul R. Co-morbidity of personality disorders in individuals with substance use disorders. Eur Psychiatry 2001; 16: 274-282
    CrossrefPubMedGoogle Scholar
  • 19 Moran P, Coffey C, Mann A. et al. Personality and substance use disorders in young adults. Br J Psychiatry 2006; 188: 374-379
    CrossrefPubMedGoogle Scholar
  • 20 Walter M, Gunderson JG, Zanarini MC. et al. New onsets of substance use disorders in borderline personality disorder over seven years of follow-ups. Addiction 2009; 204: 97-103
    CrossrefPubMedGoogle Scholar
  • 21 Moggi F. Doppeldiagnosen. Komorbidität von psychischen Störungen und Sucht. 2. Aufl. Bern: Huber; 2007
    Google Scholar
  • 22 Walter M, Gouzoulis-Mayfrank E. (Hrsg.) Psychische Störungen und Suchterkrankungen. 2. Aufl. Stuttgart: Kohlhammer; 2019
    Google Scholar
  • 23 Walter M, Dammann G. Abhängigkeitserkrankungen und Persönlichkeitsstörungen: Eine aktuelle Übersicht aus neurobiologischer und psychodynamischer Perspektive. Psychotherapeut 2012; 57: 425-233
    CrossrefPubMedGoogle Scholar
  • 24 Euler S, Stöbi D, Sowislo J. et al. Grandiose and vulnerable narcissism in borderline personality disorder. Psychopathology 2018; 51: 110-121
    CrossrefPubMedGoogle Scholar
  • 25 Cohen P, Chen H, Crawford TN. et al. Personality disorders in early adolescence and the development of later substance use disorders in the general population. Drug Alcohol Depend 2007; 88: S71-S84
    CrossrefPubMedGoogle Scholar
  • 26 Makris N, Oscar-Berman M, Kim S. et al. Decreased volume of the brain reward system in alcoholism. Biol Psychiatry 2008; 64: 192-202
    CrossrefPubMedGoogle Scholar
  • 27 Tanabe J, Tregellas JR, Dalwani M. et al. Medial orbitofrontal cortex gray matter is reduced in abstinent substance-dependent individuals. Biol Psychiatry 2009; 65: 160-164
    CrossrefPubMedGoogle Scholar
  • 28 Moreno-López L, Catena A, Fernández-Serrano MJ. et al. Trait impulsivity and prefrontal gray matter reductions in cocaine dependent individuals. Drug Alcohol Depend 2012; 125: 208-214
    CrossrefPubMedGoogle Scholar
  • 29 Ersche KD, Turton AJ, Chamberlain SR. et al. Cognitive dysfunction and anxious-impulsive personality traits are endophenotypes for drug dependence. Am J Psychiatry 2012; 169: 926-936
    CrossrefPubMedGoogle Scholar
  • 30 Buckholtz JW, Treadway MT, Cowan RL. et al. Dopaminergic network differences in human impulsivity. Science 2010; 329: 532
    CrossrefPubMedGoogle Scholar
  • 31 Soyka M, Batra A, Heinz A. et al. (Hrsg.) Suchtmedizin. München: Urban & Fischer Verlag/Elsevier; 2018
    Google Scholar
  • 32 Langås AM, Malt UF, Opjordsmoen S. In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry 2012; 12: 180
    CrossrefPubMedGoogle Scholar
  • 33 Galen LW, Brower KJ, Gillespie BW. et al. Sociopathy, gender, and treatment outcome among outpatient substance abusers. Drug Alcohol Depend 2000; 61: 23-33
    CrossrefPubMedGoogle Scholar
  • 34 Fenton MC, Keyes K, Geier T. et al. Psychiatric comorbidity and the persistence of drug use disorders in the United States. Addiction 2012; 107: 599-609
    CrossrefPubMedGoogle Scholar
  • 35 Verheul R, Kranzler HR, Poling J. et al. Axis I and Axis II disorders in alcoholics and drug addicts: fact or artifact?. J Stud Alcohol 2000; 61: 101-110
    CrossrefPubMedGoogle Scholar
  • 36 Zanarini MC, Frankenburg FR, Hennen J. et al. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry 2004; 161: 2108-2014
    CrossrefPubMedGoogle Scholar
  • 37 Euler S, Sollberger D, Bader K. et al. Persönlichkeitsstörungen und Sucht: Systematische Literaturübersicht zu Epidemiologie, Verlauf und Behandlung. Fortschr Neurol Psychiatr 2015; 83: 201-210
    PubMedGoogle Scholar
  • 38 Heath LM, Laporte L, Paris J. et al. Substance misuse is associated with increased psychiatric severity among treatment-seeking individuals with borderline personality disorder. J Pers Disord 2017; 31: 1-15
    PubMedGoogle Scholar
  • 39 Walter M, Dürsteler KM, Petitjean SA. et al. Psychosoziale Behandlungen bei Suchterkrankungen – Suchtspezifische Psychotherapieformen und ihre Wirksamkeit. Fortschr Neurol Psychiatr 2015; 83: 201-210
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Granero R, Fernández-Aranda F, Mestre-Bach G. et al. Cognitive behavioral therapy for compulsive buying behavior: Predictors of treatment outcome. Eur Psychiatry 2017; 39: 57-65
    CrossrefPubMedGoogle Scholar
  • 41 Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. New York: Guilford Press; 2012
    Google Scholar
  • 42 Marlatt GA, Gordon JR. Relapse Prevention: a self-control strategy for the maintenance of behavior change. New York: Guilford; 1985
    Google Scholar
  • 43 Hendershot CS, Witkiewitz K, George WH. et al. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011; 19: 6-17
    PubMedGoogle Scholar
  • 44 AWMF online 2021 https://www.awmf.org/leitlinien/detail/ll/076-001.html
    PubMed
  • 45 Linehan MM. Cognitive-behavioral treatment in borderline personality disorder. New York: Guilford Press; 1993
    Google Scholar
  • 46 Sollberger D, Walter M. Psychotherapie der Borderline-Persönlichkeitsstörung: Gemeinsamkeiten und Differenzen evidenzbasierter störungsspezifischer Behandlungen. Fortschr Neurol Psychiatr 2010; 78: 698-708
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapie der Borderline-Persönlichkeit. Stuttgart: Schattauer; 2001
    Google Scholar
  • 48 Vogt KS, Norman P. Is mentalization-based therapy effective in treating the symptoms of borderline personality disorder? A systematic review. Psychol Psychother 2019; 92: 441-464
    CrossrefPubMedGoogle Scholar
  • 49 Euler S, Walter M. Mentalisierungsbasierte Psychotherapie (MBT). 2. Aufl. Stuttgart: Kohlhammer; 2020
    CrossrefGoogle Scholar
  • 50 Pennay A, Cameron J, Reichert T. et al. A systematic review of interventions for co-occurring substance use disorder and borderline personality disorder. J Subst Abuse Treat 2011; 41: 363-373
    CrossrefPubMedGoogle Scholar
  • 51 Parmar A, Kaloiya G. Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review. Indian J Psychol Med 2018; 40: 517-527
    CrossrefPubMedGoogle Scholar
  • 52 Linehan MM, Dimeff LA, Reynolds SK. et al. Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend 2002; 67: 13-26
    CrossrefPubMedGoogle Scholar
  • 53 van den Bosch LM, Verheul R, Schippers GM. et al. Dialectical Behavior Therapy of borderline patients with and without substance use problems. Implementation and long-term effects. Addict Behav 2002; 27: 911-923
    CrossrefPubMedGoogle Scholar
  • 54 Gregory RJ, Chlebowski S, Kang D. et al. A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy (Chic) 2008; 45: 28-41
    CrossrefPubMedGoogle Scholar
  • 55 Ball SA, Cobb-Richardson P, Connolly AJ. et al. Substance abuse and personality disorders in homeless drop-in center clients: symptom severity and psychotherapy retention in a randomized clinical trial. Compr Psychiatry 2005; 46: 371-379
    CrossrefPubMedGoogle Scholar
  • 56 Walter M, Sollberger D, Euler S. Persönlichkeitsstörung und Sucht. 2. Aufl. Stuttgart: Kohlhammer; 2022
    CrossrefGoogle Scholar
  • 57 Gartlehner G, Crotty K, Kennedy S. et al. Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis. CNS Drugs 2021; 35: 1053-1067
    CrossrefPubMedGoogle Scholar
  • 58 Timäus C, Meiser M, Wiltfang J. et al. Efficacy of naltrexone in borderline personality disorder, a retrospective analysis in inpatients. Hum Psychopharmacol 2021; 36: e2800
    CrossrefPubMedGoogle Scholar
  • 59 Dom G, Moggi F. Co-occurring addictive and psychiatric disorders: A practice-based handbook from a European perspective. Co-Occurring Addictive and Psychiatric Disorders: A Practice-Based Handbook from A European Perspective. Heidelberg: Springer; 2015
    CrossrefGoogle Scholar
  • 60 Hämmig R, Köhler W, Bonorden-Kleij K. et al. Safety and tolerability of slow-release oral morphine versus methadone in the treatment of opioid dependence. J Subst Abuse Treat 2014; 47: 275-281
    CrossrefPubMedGoogle Scholar
  • 61 Magni LR, Ferrari C, Barlati S. et al. Psychopharmacological treatment in borderline personality disorder: A pilot observational study in a real-world setting. Psychiatry Res 2021; 295: 113556
    CrossrefPubMedGoogle Scholar
  • 62 Gianoli MO, Jane JS, O’Brien E. et al. Treatment for comorbid borderline personality disorder and alcohol use disorders: a review of the evidence and future recommendations. Exp Clin Psychopharmacol 2012; 20: 333-344
    CrossrefPubMedGoogle Scholar