Wilfer Tobias, Armbrust Michael, Aalderink Tim, Spitzer Carsten
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie Universitätsmedizin Rostock Gehlsheimer Str. 20 18147 Rostock Deutschland.
Schön Klinik Bad Bramstedt, Bad Bramstedt Deutschland.
Z Psychosom Med Psychother. 2021 Dec;67(4):435-450. doi: 10.13109/zptm.2021.67.4.435.
Although dissociative phenomena belong to the diagnostic criteria of borderline personality disorder (BPD) and are of high clinical relevance, their predictive significance with regard to the treatment outcome has hardly been investigated. Because some therapeutic and experimental studies suggest that dissociation can impede emotional learning and thus adversely affect the response to psychotherapy, we examined this issue in patients with BPD. In this naturalistic psychotherapy study we assessed 342 patients with BPD at the beginning and end of inpatient dialectical behavioural therapy (DBT) with self-report measures for dissociation (Questionnaire on dissociative symptoms, FDS, as German version of the Dissociative Experiences Scale, DES) as well as general and borderline specific pathology (Brief Symptom Inventory, BSI; Borderline Symptom List, BSL) and quality of life (SF-12). Both the general mental distress (BSI) and the borderline-specific pathology (BSL) as well as the psychosocial quality of life improved less in patients with initially severe dissociative symptoms than in those with less pronounced symptoms; this effect was mainly driven by the subscale derealisation of the Dissociative Experience Scale (DES), and was found particularly in women. Consistent with earlier findings, dissociative phenomena proved to be negative predictors of the therapeutic outcome in BPD women completing inpatient DBT. Whether this also applies to outpatient and other evidence-based treatment approaches for BPD remains to be clarified. Our results indicate the necessity to identify and treat dissociative symptoms as early as possible for a successful psychotherapy.
尽管分离现象属于边缘型人格障碍（BPD）的诊断标准且具有高度临床相关性，但它们对治疗结果的预测意义几乎未被研究过。由于一些治疗和实验研究表明，分离会阻碍情感学习，从而对心理治疗的反应产生不利影响，我们在BPD患者中研究了这个问题。在这项自然主义心理治疗研究中，我们在住院辩证行为疗法（DBT）开始和结束时，使用分离的自我报告测量方法（分离症状问卷，FDS，作为分离体验量表德语版DES）以及一般和边缘型人格障碍特定的病理学指标（简明症状量表，BSI；边缘型症状清单，BSL）和生活质量（SF - 12）对342名BPD患者进行了评估。最初有严重分离症状的患者，其一般精神痛苦（BSI）、边缘型人格障碍特定的病理学指标（BSL）以及心理社会生活质量的改善程度均低于症状较轻的患者；这种效应主要由分离体验量表（DES）的现实解体分量表驱动，且在女性中尤为明显。与早期研究结果一致，分离现象被证明是完成住院DBT的BPD女性治疗结果的负性预测指标。这是否也适用于BPD的门诊治疗和其他循证治疗方法仍有待阐明。我们的结果表明，为了成功进行心理治疗，有必要尽早识别和治疗分离症状。
