Dissoziation – eine interdisziplinäre Herausforderung

Dissoziative Phänomene erfordern zunehmend neurologische sowie psychiatrische Aufmerksamkeit in Praxis und Klinik, um sie frühzeitig zu erkennen und zu diagnostizieren und den Patienten eine entsprechende Behandlung zukommen zu lassen. In diesem Artikel werden die dissoziativen Störungen unter Berücksichtigung der neuen Klassifikation der ICD-11 vorgestellt sowie entsprechende diagnostische und therapeutische Maßnahmen beschrieben.

Abstract

Dissociative phenomena are not only encountered in everyday life, but increasingly require neurological as well as psychiatric attention in practice and clinic in order to recognize and diagnose corresponding phenomena at an early stage and to provide patients with appropriate treatment. In this article, dissociative disorders, taking into account the new classification of the ICD-11, are presented and corresponding diagnostics and therapeutic measures are described.

Schlüsselwörter

Dissoziation - Komorbiditäten - ICD-11 - Psychotherapie - Pharmakotherapie

Key words

Dissociative disorders - comorbidity - ICD-11 - psychotherapy - pharmacotherapy

Publication History

Article published online:
13 April 2023

• Literatur

• 1 Dell P, OʼNeil J. Dissociation and the dissociative disorders. New York: Routledge; 2014
• 2 World Health Organisation (WHO). ICD-11 – International Classification of Diseases. 11th ed.. Geneva, Switzerland: WHO; 2022
• 3 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed.. Washington, DC: American Psychiatric Association; 2013
• 4 Perez D, Hunt A, Sharma N. Cautionary notes on diagnosing functional neuralgic disorder as a neurologist-in-training. Neurol Clin Pract 2020; 10
• 5 Steinberg M. Advances in the clinical assessment of dissociation: the SCID-D-R. Bull Menning Clin 2000; 64: 146-163
• 6 Lynn S, Maxwell R, Merckelback H. et al. Dissociation and its disorders: competing models, future directions, and a way forward. Clin Psychol Rev 2019; 73: 101755
• 7 Lyssenko L, Schmahl C, Bockhacker L. et al. Dissociation in psychiatric disorders: a meta-analysis of studies using the Dissociative Experiences Scale. Am J Psychiatr 2018; 175: 1
• 8 Spitzer C, Stieglitz R, Feryberger H. et al. Fragebogen zu dissoziativen Symptomen (FDS). Psychother Psychosom Med Psychol 1998; 48: 223-229
• 9 Rajkumar R. The molecular genetics of dissociative symptomatology: a transdiagnostic literature review. Genes 2022; 13: 843
• 10 Giesbrecht T, Smeets T, Leppink J. et al. Acute dissociation after one night of sleep loss. Psychol Consc 2013; 1: 150-159
• 11 Langeland W, Jepsen E, Brand B. et al. The economic burden of dissociative disorders: a qualitative systematic review of empirical studies. Psychol Trauma 2020; 12: 730-738
• 12 Lotfinia S, Sorge Z, Mertens Y. et al. Structural and functional brain alterations in psychiatric patient with dissociative experiences: a systematic review of magentic resonance imaging studies. J Psychiatr Res 2020; 128: 5-15
• 13 Chalavi S, Vissia E, Giesen M. et al. Abnormal hippocampal morpholgy in dissociative identity disorder and post-traumatic stress-disorder correlates with childhood trauma and dissociative symptoms. Hum Brain Mapp 2015; 36: 1692-1704
• 14 Deutsches Kollegium für Psychosomatische Medizin (DKPM), Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie e.V. (DGPM), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) et al. S3-Leitlinie „Funktionelle Körperbeschwerden“, 2018. AWMF Register-Nr. 051-001. Im Internet: https://register.awmf.org/assets/guidelines/051-001l_S3_Funktionelle_Koerperbeschwerden_2018-11.pdf (Stand: 11.01.2023)
• 15 International Society for Study of Dissociation. Guidelines for treating dissociative identify disorder in adults. J Trauma Diss 2005; 6: 69-149
• 16 Brand B, Myrick A, Loewenstein R. et al. A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychol Trauma 2012; 4: 490-500
• 17 Spitzer C, Baron S, Freyberger HJ. et al. Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Austral New Zeal J Psychiatr 2007; 41: 682-687
• 18 Goldstein L, Robinson E, Millers J. et al. Cognitive behavioral therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomized controlled trial. Lancet Psychiatr 2020; 7: 491-505
• 19 Pape W, Wöller W. Low dose naltrexone in the treatment of dissociative symptoms. Nervenarzt 2015; 86: 346-351
• 20 Simeon D, Guralnik O, Schneider J. et al. Fluoxetine therapy in depersonalization disorder: randomized controlled trail. Br J Psychiatr 2004; 85: 31-36