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Themenschwerpunkt

Aktueller Stand der Psychotherapie von Persönlichkeitsstörungen

Published Online:March 21, 2018https://doi.org/10.1024/1661-4747/a000345

Abstract

Zusammenfassung. Vor dem Hintergrund der epidemiologischen Bedeutung und den fortschreitenden Erkenntnissen zu biopsychosozialen Ätiopathogenesemodellen fokussiert diese Arbeit auf den aktuellen Stand der Psychotherapie von Persönlichkeitsstörungen als Behandlungsmethode der Wahl. Der Schwerpunkt wird dabei auf die Borderline-, antisoziale, narzisstische und ängstlich-vermeidende Persönlichkeitsstörung gelegt. Gerade für die Borderline-Persönlichkeitsstörung (BPS) als klinisch bedeutsamste Persönlichkeitsstörung sind verschiedene schulenübergreifende, transtheoretische Therapieansätze entwickelt und hinsichtlich ihrer Wirksamkeit mit guten Ergebnissen empirisch überprüft worden. Zu diesen evidenzbasierten Behandlungsverfahren zählen die Dialektisch-Behaviorale Therapie (DBT), die Mentalisierungsbasierte Therapie (MBT), die Übertragungsfokussierte Therapie (TFP) und die Schematherapie (ST), die alle in allgemeinen Grundprinzipien konvergieren. Auch für die antisoziale, narzisstische und ängstlich-vermeidende Persönlichkeitsstörung können allgemeine Behandlungsprinzipien formuliert werden, die den jeweiligen Besonderheiten der Störungsbilder Rechnung tragen; allerdings liegen diesbezüglich weniger Hinweise auf die Wirksamkeitsevidenz von Psychotherapie vor als bei der BPS. Abschließend werden zukünftige Herausforderungen für die Psychotherapie(-forschung) diskutiert.


Current Practice in Psychotherapy of Personality Disorders

Abstract. Given the epidemiological relevance and the growing insights into biopsychosocial mechanisms and etiological pathways, this paper describes the current practice in psychotherapy as treatment of choice for patients with personality disorders. The main focus is on borderline, antisocial, narcissistic and avoidant personality disorders. Borderline personality disorder (BPD) is clinically the most relevant, i.e. the most prevalent and most disabling condition, for which several transtheoretical psychotherapeutic approaches have been developed. Their effectiveness has empirically been validated with encouraging results. These evidence-based psychotherapies are dialectical behaviour therapy (DBT), mentalization-based treatment (MBT), transference-focused psychotherapy (TFP), and schema therapy (ST). All of them converge in general principles necessary for a successful treatment. Likewise, general guidelines can be established for antisocial, narcissistic and avoidant personality disorders taking into account their specific features. However, there is less evidence for the effectiveness of psychotherapy for these disorders than for BPD. Finally, future challenges with regard to psychotherapy research, clinical management and implementation of evidence-based treatments in everyday practice are discussed.

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