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Psychopathologie und Psychotherapie der Borderline-Persönlichkeitsstörung

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Psychopathology and psychotherapy of borderline personality disorder

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Zusammenfassung

Mit einer Lebenszeitprävalenz von etwa 3% gehört die Borderline-Persönlichkeitsstörung (BPS) gerade in der mittleren Adoleszenz und im jungen Erwachsenenalter zu den häufigen psychiatrischen Störungsbildern. Im Zentrum stehen Probleme der Affektregulation, der Identität und der sozialen Interaktion. In den letzen Jahren wurde eine Reihe störungsspezifischer Therapieverfahren entwickelt, von denen drei wissenschaftliche Wirksamkeitsnachweise erbrachten: dialektisch-behaviorale Therapie (DBT), mentalisierungsbasierte Therapie (MBT) und Schematherapie. Obgleich die Datenlage konsistent eine Überlegenheit dieser Therapieprogramme gegenüber unspezifischen Behandlungsversuchen zeigt, hinkt die Versorgungsrealität in der BRD hinterher. Nur etwa jeder tausendste Borderline-Patient erhält derzeit in Deutschland leitlinienkonforme ambulante Psychotherapie. Dementsprechend hoch sind mit 4 Mrd. EUR die jährlichen Kosten, die für stationäre Behandlung der BPS ausgegeben werden. Das sind etwa 20% der Gesamtkosten die pro Jahr in Deutschland für psychiatrische Störungen ausgegeben werden.

Summary

With a lifetime prevalence of about 3%, borderline personality disorder is a frequent and often debilitating psychiatric disorder, especially during adolescence. Most features of typical borderline pathology can be classified into three dimensions: disturbed affect regulation, identity disturbance and problems in social interaction. Within the last decade several treatment programs have been tailored to the specific needs of borderline therapy and three of them have meanwhile shown empirically proven evidence: dialectical behavior therapy (DBT), mentalization-based therapy (MBT) and schema therapy. Although the studies showed clear superiority of specifically designed treatment programs compared to non-structured standard care, implementation of these programs in the German health care system is far from sufficient. Only one out of every thousand patients suffering from borderline personality disorder receives evidence-based outpatient psychotherapy. This is mirrored by the annual costs for inpatient treatment extending to 4 billion Euros, which is approximately 20% of the total costs for psychiatric care in Germany.

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Authors and Affiliations

  1. Zentralinstitut für Seelische Gesundheit Mannheim , Klinik für Psychosomatische Medizin und Psychotherapie, J5, 68159, Mannheim, Deutschland

    M. Bohus

  2. Institut für Psychologie an der CAU Kiel, Kiel, Deutschland

    C. Kröger

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  1. M. Bohus
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  2. C. Kröger
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Correspondence to M. Bohus.

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Bohus, M., Kröger, C. Psychopathologie und Psychotherapie der Borderline-Persönlichkeitsstörung. Nervenarzt 82, 16–24 (2011). https://doi.org/10.1007/s00115-010-3126-1

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  • DOI: https://doi.org/10.1007/s00115-010-3126-1

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