Persönlichkeitsfragebögen

The influence of defensivity, measured by validity scales of personality inventories (MMPI-K, FPI-R, GIESSEN-Test) on test results and psychotherapy outcome was studied in 309 patients treated with inpatient client-centered therapy. In general, psychotherapy patients exhibited low defensivity. 25% of patients, who denied psychopathology at admission, did so at discharge and to some extent at follow-up, demonstrating an ”especially good outcome” (means). Relative improvement (effect sizes), however, was significantly diminished in psychopathology scales and significantly enlarged in validity scales. – Results are discussed with regard to prior hypotheses about the influence of defensivity.     

Behandlungsleitlinie Persönlichkeitsstörungen

The S2 guidelines for the treatment of personality disorders (PD) are summarized. In the diagnostic assessment of personality disorders a clinical interview should be supplemented by (semi-) structured clinical interviews and self-report measures for the categorical and dimensional assessment of PDs. The results of the assessment process should be communicated to the patient based on a psycho-educational framework. The diagnosis should always be linked to the patient’s individual history. Psychotherapy is the treatment of choice for personality disorders. A detailed analysis of the patient’s problems as well as the definition of a hierarchy of treatment goals are part of the process of treatment planning. For three PDs empirical evidence for treatment approaches is available: (1) dialectical behavior therapy, mentalization-based therapy, schema focused therapy and transference focused therapy all proved beneficial in the treatment of borderline personality disorder. Cognitive-behavior therapy proved helpful in the treatment of (2) dissociative personality disorder and (3) avoidant personality disorder. There is limited evidence for interpersonal therapy and psychodynamic therapies in the treatment of avoidant personality disorder.     

Narzisstische Persönlichkeitsstörung

Narcissism is a multifaceted term which encompasses traits of normal personality as well as a specific personality disorder. While much research has been concerned with narcissism as a trait there are only few empirical studies on narcissistic personality disorder (NPS). The current diagnostic system of NPS according to DSM-5 (section II) focuses on grandiose narcissism whereas vulnerable narcissism, which is emphasized by clinicians and researchers, has not yet been recognized. While treating NPD patients an increased suicide risk has to be taken into consideration. Psychotherapy of narcissistic patients mainly focuses on processes during patient-therapist interactions, the analysis and processing of grandiose and vulnerable schemas, emotion regulation techniques and a correction of narcissistic behavior in favor of prosocial interactions.     

Persönlichkeitsstörung und Intelligenzminderung

There have previously been only few objective investigations on the combined occurrence of intellectual disability and personality disorder. Despite this difficulty, from the current clinical viewpoint there is no doubt that at least people with mild intellectual disability can also develop personality disorders. In slight degrees of intellectual disability it is possible to psychopathologically describe the typical symptoms objectively. For the disorder symptomatic of combined personality disorder in people with an intellectual disability, there are no confirmed facts, publications or diagnostic rules. The diagnostic assignment of behavioral abnormalites as combined personality disorder with dependent and infantile components in people with intellectual diasabilities still does not seem to be justified. In people with medium to severe mental disorders only the comprehensive term “behavioral abnormalities” should be applied.     

Diagnostik von Persönlichkeitsstörungen

Diagnosing and classifying personality disorders is complex and difficult from both the scientific and clinical perspectives. Dimensional and categorical models and assessment instruments of personality disorders, and different (behavioral and psychodynamic orientated) clinical procedures are described. Furthermore, an integrative view on clinical practice is presented.     

Die Behandlung von Borderline-Persönlichkeitsstörungen

Zusammenfassung Bereits 1681 beklagte sich ein englischer Arzt in einem Brief über Patienten, die ohne jedes Ma? jene lieben, die sie alsbald ohne jeden Grund hassen würden. Weiterhin seien pl?tzliche Ausbrüche von Wut, Schmerz, Angst oder ?hnlichen Emotionen zu beobachten. Mit dieser frühen Beschreibung typischer Borderline-Symptome wird die Darstellung der Entwicklung der Theorie der Borderline-St?rung von den Anf?ngen bis heute eingeleitet. Vor diesem Hintergrund werden der Stand der Diagnostik und die derzeit wichtigen Behandlungskonzepte umrissen, und zwar die psychodynamischen, verhaltenstherapeutischen und klientenzentrierten Ans?tze. Es wird dargelegt, welche Antworten es auf die Frage gibt, was das angemessene therapeutische Setting ist, insbesondere mit Blick auf station?re Behandlungskonzepte. Die vorliegenden empirischen Studien best?tigen die Wirksamkeit von Psychotherapie bei Borderline-St?rungen. Die geringe Zahl der Studien belegt aber auch die Schwierigkeit der empirischen Forschung in diesem Bereich. Der abschlie?ende Ausblick in die Zukunft der Psychotherapie der Borderline-Pers?nlichkeitsst?rungen prognostiziert eine weitere Zunahme von Pers?nlichkeitsst?rungen im Spektrum psychiatrischer Erkrankungen und eine zunehmende Differenzierung des Behandlungsangebots bzw. Spezialisierung der Behandler.      

Narzißtische Persönlichkeitsstörungen

Zusammenfassung Der Begriff des Narzi?mus wird aus historischen, soziologischen, anthropologischen, mythologischen und etymologischen Quellen hergeleitet und dann in die verschiedenen psychoanalytischen Theorien eingeordnet. Die theoretischen Grundpositionen zum Narzi?mus und zur Auffassung narzi?tischer Pers?nlichkeitsst?rungen werden ausführlich erl?utert. Die Annahme eines prim?ren Narzi?mus wird anhand der theoretischen Vorstellungen von Freud, Grunberger, Mahler und Kohut erkl?rt, die Annahme einer prim?ren Objektbeziehung durch die Theorien von Ferenczi, Balint, Klein und Winnicott illustriert. Anschlie?end werden die Konzeptionen des Narzi?mus im Rahmen der Triebtheorie bzw. als eigenst?ndige Entwicklungslinie (Kohut) erl?utert. Grunberger nimmt dabei eine Mittelstellung ein. Kohut und Kernberg stehen sich gegenüber, wenn es um die Einordnung des Narzi?mus als pathologisches Ph?nomen (Kernberg) oder als Entwicklungsarretierung (Kohut) geht. Es schlie?t sich ein Abschnitt über die klassifikatorisch-deskriptive Erfassung des Narzi?mus an, in dem die Auffassungen der narzi?tischen Pers?nlichkeitsst?rung im Rahmen der g?ngigen Klassifikationssysteme (DSM-IV, ICD-10, OPD) beschrieben werden. Ebenso finden die Testdiagnostik sowie interpersonelle Ans?tze Berücksichtigung. Danach werden die Befunde der modernen S?uglingsforschung und deren Auswirkungen auf ein ver?ndertes Verst?ndnis der narzi?tischen Pers?nlichkeitsst?rung dargestellt. Die übersicht schlie?t mit einer differenzierten Betrachtung der unterschiedlichen therapeutischen Vorgehensweisen.      

Beziehungsökologische Therapie bei Panikstörung

Background

In 2000/2001 the authors presented the theory and practice of the ecological approach to the psychotherapy of panic disorders. The aim of the present study was to investigate the psychotherapeutic effectiveness of its application, supplemented by cognitive behavioural elements. According to the ecological approach, panic disorder arises whenever external changes in the living conditions enforce changes in professional or interpersonal relationships, which had been previously postponed and/or avoided out of fear of their consequences.

Methods

A total of 24 therapies consisting of 11–20 sessions were examined. Patients were examined 5 times from the beginning of the therapy until at least 1 year after cessation. Standardized questionnaires for the diagnosis and severity of the panic syndrome were used including the Panic and Agoraphobia Scale (PAS), the Hamilton Anxiety Scale (HAMA), the Symptom Checklist (SCL) 90-R and a relationship questionnaire.

Results

In the subjects’ self-evaluation 67% had recovered or showed only mild symptoms 1 year after therapy compared to 75% in the evaluation by the therapists. Effect sizes before and after therapy varied between 0.78 and 2.73 and all were significant. In addition, we developed a questionnaire on relationships, according to the ecological hypothesis. This showed that more than 80% of the subjects experienced essential changes in their relationships prior to the onset of the panic disorder requiring further developmental changes, which could be mastered with increasing success in the course of therapy.

Conclusions

Compared to other studies the combination of ecological and cognitive-behavioural approaches in this study resulted in impressive symptom and therapy reduction in less than 20 sessions.     

Psychotherapeutischer Prozess und Persönlichkeitsstörungen

This paper begins with a cursory overview of psychotherapy outcome research for personality disorders; however, relatively little is known about process research or process outcome relationships. It then focuses on relevant patient and therapist variables. Significant controversies in personality disorder treatment techniques are examined. Initially, studies generally associated transference interpretation with less favorable therapy outcomes. Recent work supports the possibility of differentiated correlations. There is increasing evidence that a moderate amount of transference interpretation and perhaps even a therapeutic alliance that is not so good, maybe indicative of an inner conflict with the therapist relationship, could ultimately be beneficial. This association most probably does not exist in cluster C personality disorders. A problem with this type of research is that clear definitions are often lacking. This complicates comparisons between studies and the influence of other mediating variables remains vague.     

Schlafstörung

A 41 year-old woman presented with restlessness and constricting and pressing dysesthesia in both calves and feet. These symptoms bother her especially in the evening while watching TV and later while lying in bed. She has to stand up repeatedly and walk around in her flat to obtain some temporary relief of her symptoms, which first appeared during her pregnancy 6 years ago and have become gradually worse over time. The patient complains that nowadays she lies awake in bed for up to 2 h until she can go to sleep several times a week. She wakes up 2–3 times a night only to find herself fighting to go back to sleep. During the day she noticed difficulties concentrating during work and frequently reacts angrily towards her husband and her daughter.     

Libidostörungen

Individual problems, difficulties in the partnership, handicaps of the body and the influence of the society contribute to sexual problems. In this article sexual desire und sexual desire disorders are defined. Reasons for the increase in sexual desire disorders over the last twenty years especially among women are discussed. Two clinical cases show different causes of hyposexual desire and the resulting difficulties in the relationship. Using a systemic approach the patients learn new definitions of their problem, which are more useful to solve the problem of not wanting to want. Afterwards the author tries to show the many psychosomatic reasons of disturbed sexual desire to help to see this problem from different points of view. Finally, a list of questions is presented, that may help to clarify the personal reasons of desire disorders and may help to find out the next useful steps to solve the problem. Understanding individual reasons and clarifying the influence of society can help to diminish feelings of anxiety, shame and guilt.     

Körperinszenierungen

Zusammenfassung Formen zeitgenössischen Körperagierens in der Adoleszenz, wie besondere Haartracht (Punkfrisuren), Tätowierungen und Piercings, sowie pathologische Körpermanipulationen, wie Selbstverletzung und Essstörungen, haben eine auffallende Ähnlichkeit bzw. gehen parallel mit den Körperritualen der sog. Naturvölker, teilweise auch mit denen unseres eigenen Kulturkreises. Bei aller Ähnlichkeit sind jedoch drei in ihrem Wesen verschiedene Formen zu unterscheiden: 1. Die gesellschaftskonformen Körperpraktiken, die der Tradition einer sozialen Gruppe entsprechen und öffentlich-rituell Identitätsschritte in der menschlichen Entwicklung markieren (insbesondere Initiation in der Adoleszenz), wie wir es bei den Naturvölkern und in Rudimenten in unserer Kultur finden. 2. Die Benutzung des eigenen Körpers, um sich als Adoleszenter meist in Peer-Groups provozierend und rebellierend gegen überkommene Traditionen abzugrenzen; hier wird am Körper eine passagere Gegenidentifikation markiert, die gerade nicht den überkommenen Traditionen entspricht, jedoch wieder verlassen wird und in eine reife Erwachsenenidentität übergeht. 3. Die pathologischen Formen des Körperagierens dagegen bedeuten Entwicklungsstillstand und Arretierung der Identitätsentwicklung; sie müssen (wie eine Sucht) ständig wiederholt werden, um eine prekäre Ersatzidentität aufrechtzuerhalten, weil die Entwicklung einer autonomen Identität mit psychosenaher Trennungsangst verbunden wäre. Nur Menschen manipulieren derart ihren Körper, und zwar seit Menschengedenken, als ob der Mensch ständig symbolisch die Natur beherrschen müsste, wie auch sonst die natürliche Umwelt, in mehr oder weniger harmloser bzw. destruktiver Form, und der Körper ist der ihm nächste Teil der Natur.

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Body enactmentsOn parallels between body acting of primitive cultures, contemporary adolescents and pathologic forms

There are obvious parallels between contemporary body acting of adolescents such as the manner of wearing ones hair, using tattoos and piercings, as well as some kinds of pathologic body manipulation (like self-inflicting or eating disorders), and ritual body performances of the so-called primitive or savage cultures. But in part there are also parallels with ubiquituous body activities in our culture. In this paper three groups of body-acting are distinguished: 1. In conformity to social rules traditional body practices are marking steps of identity development, for example rites of initiation in primitive cultures and rudimentary ceremonies in our culture. 2. Ones own body is used to define oneself in adolescence rebelliously against social traditions. Such unconventional body-acting occurs in peer-groups and is seen as a passagère phenomenon in average identity development. 3. Pathologic forms of self destructive body-acting signify a cessation of development. In an addiction-like repetition they build up a precarious identity surrogate, because arriving at an autonomous identity would be connected with psychotic separation anxiety. Only human beings are able to treat their bodies (in normality and pathology), as if humans are constantly compelled to dominate nature symbolically in every moment, and their bodies are the nearest part of nature to them.

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Erweiterte Fassung dreier Vorträge: Psychotherapietage NRW, 1. Nov. 2002, Bad Salzuflen; Symposium der Wissenschaftlichen Gesellschaft Freiberg der Arbeitskreise für Psychoanalyse in Österreich, Salzburg, März 2003; Fachtagung der Vereinigung Ostschweizer Psychotherapeutinnen und Psychotherapeuten, St. Gallen, September 2003.