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Was wissen wir heute über die Borderline-Persönlichkeitsstörung? Aktuelles zu Ätiologie, Diagnostik und Therapie

What do we know about borderline personality disorder? Current aspects of etiology, diagnostics and treatment

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Zusammenfassung

Hintergrund

Die Borderline-Persönlichkeitsstörung (BPS) gilt als schwerwiegende psychische Störung mit hoher Belastung für Patienten, Familienmitglieder und das Gesundheitssystem. Die letzten Jahre brachten deutliche Fortschritte im Verständnis und in der Therapie der BPS, was zu einer früheren Diagnose und besseren Behandlungsergebnissen geführt hat.

Ziel der Arbeit

Der Artikel skizziert den aktuellen Wissensstand zu Epidemiologie, Diagnostik, Psychopathologie und Behandlung der BPS und zeigt offene Fragen auf.

Material und Methoden

Mittels eines narrativen Reviews auf Basis einer Literatursuche in den Datenbanken PubMed, PsycINFO und EMBASE werden die neuesten Entwicklungen zum Thema BPS für die Bereiche Diagnostik, Epidemiologie, Ätiologie und Therapie beleuchtet. Hierfür wurden, wo möglich, systematische Übersichtsarbeiten und Metaanalysen sowie evidenzbasierte Praxisleitlinien berücksichtigt.

Stand der Wissenschaft

Im Zentrum der BPS stehen Störungen der Emotionsregulation, des Selbstbildes und der zwischenmenschlichen Interaktion. Die Suizidraten liegen zwischen 2 und 5 %, die Lebenserwartung ist gegenüber der Normalpopulation deutlich verkürzt. Die Wirksamkeit differenzierter, störungsspezifischer Psychotherapie (insbesondere dialektisch-behaviorale Therapie) ist gut belegt. Die psychotherapeutische Versorgung im ambulanten Sektor, insbesondere im Bereich der Kinder- und Jugendpsychiatrie, ist noch immer ungenügend.

Perspektiven

Fragen zur Ätiopathologie, insbesondere genetische und postulierte neurobiologische Parameter, die für eine affektive Hypersensitivität determinieren, sind weitgehend offen. Nosologisch ist die Abgrenzung zur komorbiden posttraumatischen Belastungsstörung (PTBS) sicherlich ein wichtiges Thema, das auch therapeutische Konsequenzen hat.

Abstract

Background

Borderline personality disorder (BPS) is considered as a severe mental disorder with a high burden for patients, family members and the healthcare system. Recent years have brought significant advances in understanding and treating BP, leading to an earlier diagnosis and better treatment outcomes.

Objective

This article outlines the current state of knowledge on the epidemiology, diagnostics, psychopathology and treatment of BPD and identifies open questions.

Material and methods

Based on a literature search in the PubMed, PsycINFO and EMBASE databases, the latest developments in the topic of BPD for the areas of diagnostics, epidemiology, etiology and treatment are illuminated in a narrative review. Where possible systematic review articles, meta-analyses and evidence-based practice guidelines were also considered.

State of the science

At the core of BPS are disorders of emotion regulation, self-image, and interpersonal interaction. The suicide rates range from 2% to 5% and life expectancy is significantly shortened compared with the general population. The effectiveness of differentiated, disorder-specific psychotherapy (especially dialectic behavioral therapy, DBT) is well established. Psychotherapeutic care in the outpatient sector, especially in the field of pediatric and adolescent psychiatry, is still insufficient.

Perspectives

Questions about the etiopathology, especially genetic and postulated neurobiological parameters that determine affective hypersensitivity, are largely open. Nosologically, the differentiation from comorbid complex posttraumatic stress disorder (cPTSD) is certainly an important issue, which also has therapeutic consequences.

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Author information

Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Mainz, Mainz, Deutschland

    Jutta Stoffers-Winterling & Klaus Lieb

  2. Abteilung für Klinische Psychologie, Leiden Institute of Brain and Cognitio, AK Leiden, Universität Leiden, Leiden, Niederlande

    Annegret Krause-Utz

  3. Institut für Psychiatrische und Psychosomatische Psychotherapie, Lehrstuhl für Psychosomatische Medizin und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, Zentralinstitut für Seelische Gesundheit Mannheim, J 5, 68159, Mannheim, Deutschland

    Martin Bohus

  4. Harvard Medical School, Boston, USA

    Martin Bohus

Authors
  1. Jutta Stoffers-Winterling
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  2. Annegret Krause-Utz
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  3. Klaus Lieb
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  4. Martin Bohus
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Corresponding author

Correspondence to Martin Bohus.

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Interessenkonflikt

J. Stoffers-Winterling, A. Krause-Utz und K. Lieb geben an, dass keine finanzielle Interessenkonflikte bestehen. M. Bohus erhält Erlöse aus Büchern, Seminaren und Workshops zum Thema der Dialektisch Behavioralen Therapie, ist Vorstand des Deutschen Dachverbandes DBT und Mitinhaber der Arbeitsgemeinschaft Wissenschaftliche Psychotherapie Freiburg.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Stoffers-Winterling, J., Krause-Utz, A., Lieb, K. et al. Was wissen wir heute über die Borderline-Persönlichkeitsstörung? Aktuelles zu Ätiologie, Diagnostik und Therapie. Nervenarzt 92, 643–652 (2021). https://doi.org/10.1007/s00115-021-01140-x

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