Alexithymie bei der Borderline-Persönlichkeitsstörung

Zusammenfassung

Gegenstand und Ziel: Alexithymie, also Defizite einer Person, die eigenen Gefühle wahrzunehmen und zu kommunizieren, stellt ein häufiges Symptom bei Patienten mit Borderline-Persönlichkeitsstörung (BPS) dar. Viele Patienten haben frühkindliche traumatische Erlebnisse wie emotionale Vernachlässigung oder Missbrauch erlebt. Die Zusammenhänge aversiver Erfahrungen mit Alexithymie sind aber bisher kaum untersucht. Material und Methoden: 80 BPS-Patienten wurden mit einer Kontrollgruppe von 49 gesunden Probanden verglichen. Als Testverfahren wurden die Toronto-Alexithymie-Skala (TAS-20), das Childhood Trauma Questionnaire (CTQ) und der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE) eingesetzt. Ergebnisse: Die BPS-Gruppe hatte hochsignifikant höhere Alexithymie-Werte im TAS-20 als die Kontrollgruppe; dies galt ebenso für die Belastungen durch frühkindliche Traumata und Unterschiede bezüglich des erinnerten elterlichen Erziehungsverhaltens. Dabei zeigte sich eine Korrelation von Alexithymie mit erlebtem emotionalem Missbrauch sowie erinnerter „Kontrolle und Überbehütung“ durch beide Elternteile. Schlussfolgerung und klinische Relevanz: Alexithymie ist bei der BPS ein häufiges Symptom. Ein Zusammenhang mit frühen aversiven Erfahrungen ist anzunehmen, bedarf aber weiterer Studien, insbesondere unter Einbeziehung des Bindungsstils. Dies könnte Implikationen für eine individuellere und differenziertere Psychotherapie haben.

Summary

Objective: Alexithymia, i. e. difficulties in experiencing and communicating one’s feelings, is a frequent symptom in Borderline Personality Disorder (BPD). Many patients describe traumatic childhood experiences (e. g. emotional neglect or abuse), yet possible connections between alexithymia and early adversity have barely been examined. Material and methods: Eighty patients diagnosed with BPD were compared to a control group consisting of 49 healthy subjects. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20), adversity was assessed using the Childhood Trauma Questionnaire (CTQ) and a questionnaire tapping into subjects’ subjective ratings of parental upbringing. Results: TAS-20 scores were significantly higher in the BPD group compared to healthy controls; BPD patients reported more early childhood trauma and problems related to their parents’ upbringing style. Alexithymia was correlated with emotional abuse and with biparental “control and overprotection”. Conclusion and clinical relevance: Alexithymia is common in BPD patients. Although a connection to aversive early experiences seems likely, further studies which also examine attachment styles are needed. This might have implications for more individually orientated and more differentiated psychotherapeutic interventions.

Schlüsselwörter

Borderline-Persönlichkeitsstörung - Alexithymie - frühkindliche Traumatisierung - elterliches Erziehungsverhalten

Keywords

Borderline Personality Disorder - alexithymia - childhood trauma - upbringing

• Literatur

• 1 Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008; 69: 533-45.
• 2 Simeon D, Nelson D, Elias R, Greenberg J, Hollander E. Relationship of personality to dissociation and childhood trauma in borderline personality disorder. CNS Spectr 2003; 8: 755-62.
• 3 Bandelow B, Krause J, Wedekind D, Broocks A, Hajak G, Rüther E. Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls. Psychiatry Res 2005; 134: 169-79.
• 4 Herman JL, Perry JC, van der Kolk BA. Childhood trauma in borderline personality disorder. Am J Psychiatry 1989; 146: 490-5.
• 5 Ogata SN, Silk KR, Goodrich S, Lohr NE, Westen D, Hill EM. Childhood sexual and physical abuse in adult patients with borderline personality disorder. Am J Psychiatry 1990; 147: 1008-13.
• 6 Yen S, Shea MT, Battle CL, Johnson DM, Zlotnick C, Dolan-Sewell R, Skodol AE, Grilo CM, Gunderson JG, Sanislow CA, Zanarini MC, Bender DS, Rettew JB, McGlashan TH. Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study. J Nerv Ment Dis 2002; 190: 510-8.
• 7 Wingenfeld K, Schaffrath C, Rullkoetter N, Mensebach C, Schlosser N, Beblo T, Driessen M, Meyer B. Associations of childhood trauma, trauma in adulthood and previous-year stress with psychopathology in patients with major depression and borderline personality disorder. Child Abuse Negl 2011; 35: 647-54.
• 8 Taylor GJ. Alexithymia: concept, measurement, and implications for treatment. Am J Psychiatry 1984; 141: 725-32.
• 9 Nehmiah JC, Sifneos PE. Affect and fantasy in patients with psychosomatic disorders. Modern Trends in psychosomatic medicine. London: Butterworths; 1970
• 10 Moriguchi Y, Ohnishi T, Lane RD, Maeda M, Mori T, Nemoto K, Matsuda H, Komaki G. Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia. Neuroimage 2006; 32: 1472-82.
• 11 Swart M, Kortekaas R, Aleman A. Dealing with feelings: characterization of trait alexithymia on emotion regulation strategies and cognitive-emotional processing. PLoS One 2009; 4 (06) e5751.
• 12 Taylor GJ. Recent developments in alexithymia theory and research. Can J Psychiatry 2000; 45: 134-42.
• 13 Li S, Zhang B, Guo Y, Zhang J. The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry Res 2015; 227: 1-9.
• 14 Parker JD, Taylor GJ, Bagby RM, Acklin MW. Alexithymia in panic disorder and simple phobia: a comparative study. Am J Psychiatry 1993; 150 (07) 1105-7.
• 15 Speranza M, Loas G, Wallier J, Corcos M. Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study. J Psychosom Res 2007; 63: 365-71.
• 16 Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale – I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994; 38: 23-32.
• 17 Kauhanen J, Kaplan GA, Cohen RD, Julkunen J, Salonen JT. Alexithymia and risk of death in middle-aged men. J Psychosom Res 1996; 41: 541-9.
• 18 Tolmunen T, Lehto SM, Heliste M, Kurl S, Kauhanen J. Alexithymia is associated with increased cardiovascular mortality in middle-aged Finnish men. Psychosom Med 2010; 72: 187-91.
• 19 Mikolajczak M, Luminet O. Is alexithymia affected by situational stress or is it a stable trait related to emotion regulation?. Pers Individ Dif 2006; 40: 1399-1408.
• 20 Saarijärvi S, Salminen JK, Toikka T. Temporal stability of alexithymia over a five-year period in outpatients with major depression. Psychother Psychosom 2006; 75: 107-12.
• 21 Salminen JK, Saarijärvi S, Toikka T, Kauhanen J, Aärelä E. Alexithymia behaves as a personality trait over a 5-year period in Finnish general population. J Psychosom Res 2006; 61: 275-8.
• 22 Nicolò G, Semerari A, Lysaker PH, Dimaggio G, Conti L, D’Angerio S, Procacci M, Popolo R, Carcione A. Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning. Psychiatry Res 2011; 190: 37-42.
• 23 Domes G, Grabe HJ, Czieschnek D, Heinrichs M, Herpertz SC. Alexithymic traits and facial emotion recognition in borderline personality disorder. Psychother Psychosom 2011; 80: 383-5.
• 24 New AS, aan het Rot M, Ripoll LH, Perez-Rodriguez MM, Lazarus S, Zipursky E, Weinstein SR, Koenigsberg HW, Hazlett EA, Goodman M, Siever LJ. Empathy and alexithymia in borderline personality disorder: clinical and laboratory measures. J Pers Disord 2012; 26: 660-75.
• 25 Loas G, Speranza M, Pham-Scottez A, Perez-Diaz F, Corcos M. Alexithymia in adolescents with borderline personality disorder. J Psychosom Res 2012; 72: 147-52.
• 26 Evren C, Cınar O, Evren B. Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients. Compr Psychiatry 2012; 53: 854-9.
• 27 Güleç MY, Altintaş M, İnanç L, Bezgin CH, Koca EK, Güleç H. Effects of childhood trauma on somatization in major depressive disorder: The role of alexithymia. J Affect Disord 2013; 146: 137-41.
• 28 Carpenter L, Chung MC. Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychol Psychother 2011; 84: 367-88.
• 29 Hund AR, Espelage DL. Childhoods exual abuse, disordered eating, alexithymia, and general distress: A mediation model. J Couns Psychol 2005; 52: 559-573.
• 30 Elzinga B M, Bermond B, van Dyck R. The relationship between dissociative proneness and alexithymia. Psychother Psychosom 2002; 71: 104-111.
• 31 Gaher RM, Arens AM, Shishido H. Alexithymia as a mediator between childhood maltreatment and impulsivity. Stress Health 2015; 31: 274-80.
• 32 Berenbaum H. Childhood abuse, alexithymia and personality disorder. J Psychosom Res 1996; 41: 585-95.
• 33 Paivio SC, McCulloch CR. Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse Negl 2004; 28: 339-54.
• 34 Zlotnick C, Mattia JI, Zimmerman M. The relationship between posttraumatic stress disorder, childhood trauma and alexithymia in an outpatient sample. J Trauma Stress 2001; 14: 177-188.
• 35 Wittchen HU, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview für DSM-IV. Göttingen: Hogrefe Verlag; 1997
• 36 Linehan MM. Cognitive-behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993
• 37 Lumley MA, Neely LC, Burger AJ. The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Assess 2007; 89: 230-46.
• 38 Bach M, Bach D, de Zwaan M, Serim M, Böhmer F. Validierung der deutschen Version der 20-Item Toronto-Alexithymie-Skala bei Normalpersonen und psychiatrischen Patienten. Psychother Psychosom Med Psychol 1996; 46: 23-8.
• 39 Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994; 151: 1132-6.
• 40 Scher CD, Stein MB, Asmundson GJ, McCreary DR, Forde DR. The childhood trauma questionnaire in a community sample: psychometric properties and normative data. J Trauma Stress 2001; 14: 843-57.
• 41 Paivio SC, Cramer KM. Factor structure and reliability of the Childhood Trauma Questionnaire in a Canadian undergraduate student sample. Child Abuse Negl 2004; 28: 889-904.
• 42 Wingenfeld K, Spitzer C, Mensebach C, Grabe HJ, Hill A, Gast U, Schlosser N, Höpp H, Beblo T, Driessen M. Die deutsche Version des Childhood Trauma Questionnaire (CTQ). Erste Befunde zu den psychometrischen Kennwerten. Psychother Psychosom Med Psychol 2010; 60: e13.
• 43 Klinitzke G, Romppel M, Häuser W, Brähler E, Glaesmer H. Die deutsche Version des Childhood Trauma Questionnaire (CTQ) – psychometrische Eigenschaften in einer bevölkerungsrepräsentativen Stichprobe. Psychother Psychosom Med Psychol 2012; 62: 47-51.
• 44 Schumacher J, Eisemann M, Brähler E. Rückblick auf die Eltern: Der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE). Diagnostica 1999; 45: 194-204.
• 45 Lecours S, Bouchard MA. Verbal elaboration of distinct affect categories and BPD symptoms. Psychol Psychother 2011; 84: 26-41.
• 46 Krystal H. Alexithymia and psychotherapy. Am J Psychother 1979; 33: 17-31.
• 47 Ogrodniczuk JS, Piper WE, Joyce AS. Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Res 2011; 190: 43-8.
• 48 Ogrodniczuk JS, Joyce AS, Piper WE. Change in alexithymia in two dynamically informed individual psychotherapies. Psychother Psychosom 2013; 82: 61-3.
• 49 McMain S, Links PS, Guimond T, Wnuk S, Eynan R, Bergmans Y, Warwar S. An exploratory study of the relationship between changes in emotion and cognitive processes and treatment outcome in borderline personality disorder. Psychother Res 2013; 23: 658-73.
• 50 Bateman AW, Fonagy P. Mentalization-based treatment of BPD. J Pers Disord 2004; 18: 36-51.
• 51 Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for Borderline Personality: Focusing on object relations. Washington DC: American Psychiatric Pub; 2007
• 52 Young JE, Klosko JS, Weishaar ME. Schema Therapy: A practitioner’s guide. New York: Guilford Press; 2003
• 53 Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14: 245-58.
• 54 Bremner JD, Vermetten E, Mazure CM. Development and preliminary psychometric properties of an instrument for the measurement of childhood trauma: the Early Trauma Inventory. Depress Anxiety 2000; 12: 1-12.
• 55 Fonagy P, Bateman A. The development of borderline personality disorder – a mentalizing model. J Pers Disord 2008; 22: 4-21.
• 56 Zweig-Frank H, Paris J. Parents’ emotional neglect and overprotection according to the recollections of patients with borderline personality disorder. Am J Psychiatry 1991; 148: 648-51.
• 57 Fonagy P, Target M, Gergely G. Attachment and borderline personality disorder. A theory and some evidence. Psychiatr Clin North Am 2000; 23: 103.
• 58 Cravello L, Caltagirone C, Spalletta G. The SNRI venlafaxine improves emotional unawareness in patients with post-stroke depression. Hum Psychopharmacol 2009; 24: 331-6.