Nervenheilkunde 2018; 37(12): 891-896
DOI: 10.1055/s-0038-1677372
Universitätsklinikum Ulm
Georg Thieme Verlag KG Stuttgart · New York

Endokrinologische Korrelate der Borderline-Persönlichkeitsstörung

Zusammenhang mit interpersonellem und sozialevaluativem StressAssociation between interpersonal or social-evaluative stress and borderline-personality disorder in the context of endocrinological findings
J. Kröner
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
C. Schaitz
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
A. Maier
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
B. Connemann
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
Z. Sosic-Vasic
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
› Author Affiliations
Further Information

Publication History

eingegangen am: 30 September 2018

angenommen am: 12 October 2018

Publication Date:
04 January 2019 (online)

Zusammenfassung

Die Borderline-Persönlichkeitsstörung (BPS) ist eine schwerwiegende und im psychiatrischen sowie psychotherapeutischen Kontext die am häufigsten vorkommende Persönlichkeitsstörung. Sie zeichnet sich durch ein Muster von Instabilität im zwischenmenschlichen Kontakt und im Selbstbild sowie eine gesteigerte Impulsivität aus. Annahmen besagen, dass Personen mit einer BPS sehr stark auf emotionale Stimuli reagieren und Schwierigkeiten haben, ihre physiologischen Reaktionen zu kontrollieren. Die Übersichtsarbeit durchleutete die Datenbank PubMed systematisch auf Artikel zum Thema „Kortisol“ oder „Hpa“ und „psychosozialer Stress“ oder „interpersoneller Stress“ und „Borderline“. Hierbei konnten von 135 Artikeln 8 identifiziert werden, die den Suchkriterien entsprachen. Nach Evaluation der Studien können die Hypothesen bezüglich interpersoneller Stressoren teilweise bestätigt werden. Hierbei erlebten Personen mit BPS im Vergleich zu gesunden Kontrollprobanden eine erhöhte physiologische Stressreaktion, gemessen am Kortisol im Speichel, auf einen interpersonellen Konflikt. In Studien zu sozial-evaluativen Stressoren reagierten BPS-Probanden jedoch im Gegensatz zu diesen Ergebnissen auf Stress mit einer Hyporeagibilität des physiologischen und endokrinologischen Stresssystems. In Bezug auf ein Fazit bleiben die Befunde uneindeutig, was den geringen Stichprobengrößen, teilweise fehlenden Mediatorsowie Moderatorvariablen, unterschiedlichen Einschlusskriterien und Messzeitpunkten, aber auch der einseitigen Geschlechterverteilung geschuldet sein könnte.

Summary

The Borderline-Personality Disorder (BPD) is a severe mental disorder, which is one of the most common personality disorders within the psychotherapeutic context and psychiatric inpatient facilities. It is characterized by a severe pattern of instability in social and interpersonal contexts, as well as self-perception and marked impulsivity. Current theories propose that people diagnosed with BPD react strongly to emotional cues, and have difficulties to control their physiological reactions. The authors searched the database PubMed for relevant publications. 135 studies were found based on the keywords „cortisol“ and „interpersonal stress“ or „psychosocial stress“ and „borderline; 8 met inclusion criteria. Based on our findings, the theories could be partially confirmed: Participants diagnosed with BPS experienced a heightened cortisol response in reaction to interpersonal conflict discussions when compared to healthy controls. However, studies measuring the impact of social-evaluative stress on endocrinological functioning draw a different picture: When exposed to social-evaluative stress, participants with BPD experienced a hypo-responsiveness of the endocrinological stress system, manifesting in lower cortisol levels compared to healthy controls. Due to the small sample size of past studies, as well as partially missing moderating and mediating variables, varying inclusion criteria, and different measurement time points, and a one-sided gender distribution it would be presumptuous to draw a general conclusion for therapeutic practice. However, the here presented studies are able to pave the way for future research including previously missing information that could lead to a more integrated and applicable picture in regards to BPS and interpersonal stress.

 
  • Literatur

  • 1 Tomko RL. et al. Characteristics of Borderline Personality Disorder in a Community Sample.. J Pers Disord 2014; 28 (05) 734-50.
  • 2 Wagner T. et al. Krankheitskosten der Borderline Persönlichkeitsstörung aus gesellschaftlicher Perspektive.. Z Klin Psychol Psychother 2013; 42 (04) 242-55.
  • 3 Grant BF, Chou SP, Goldstein RB. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder.. J Clin 2008; 69 (04) 533-45.
  • 4 van Asselt ADI, Dirksen CD, Arntz A, Severens JL. The cost of borderline personality disorder: societal cost of illness in BPD-patients.. Eur Psychiatry 2007; 22 (06) 354-61.
  • 5 Skodol E. Functional Impairment in Patients With Schizotypal, Borderline, Avoidant, or Obsessive-Compulsive Personality Disorder.. Am J Psychiatry 2002; 159 (02) 276-83.
  • 6 D S et al. Treatment utilization by patients with personality disorders.. American Journal of Psychiatry 2001; 158: 295-302.
  • 7 Zanarini MC, Frankenburg FR, Hennen J, Silk KR. The Longitudinal Course of Borderline Psycho-pathology.. Am J Psychiatry 2003; 160: 274-83.
  • 8 Dsc L, Kruse J, Leweke F, Leichsenring F, Leibing E, Kruse J. Borderline personality disorder.. Lancet 2011; 377 (377) 74-84.
  • 9 APA.. Diagnostic and statistical manual of mental disorders: DSM-5.. Washington, D.C: American Psychiatric Association 2013; 947
  • 10 Wingenfeld K, Spitzer C, Rullkötter N, Löwe B. Borderline personality disorder: Hypothalamus pituitary adrenal axis and findings from neuroimaging studies.. Psychoneuroendocrinology 2010; 35 (01) 154-70.
  • 11 Weinberg A, Klonsky ED, Hajcak G. Autonomic impairment in Borderline Personality Disorder: A laboratory investigation.. Brain Cogn 2009; 71 (03) 279-86.
  • 12 Zimmerman DJ, Choi-Kain LW. The hypothalamic-pituitary-adrenal axis in borderline personality disorder: A review.. Harv Rev Psychiatry 2009; 17 (03) 167-83.
  • 13 Simeon D. et al. A preliminary study of cortisol and norepinephrine reactivity to psychosocial stress in borderline personality disorder with high and low dissociation.. Psychiatry Res 2007; 149 1–3 177-84.
  • 14 Walter M, Bureau J-F, Holmes BM, Bertha EA, Hollander M, Wheelis J. et al. Cortisol response to interpersonal stress in young adults with borderline personality disorder: A pilot study.. Eur Psychiatry 2008; 23 (03) 201-4.
  • 15 Aleknaviciute J, Tulen JHM, Kamperman AM, de Rijke YB, Kooiman CG, Kushner SA. Borderline and cluster C personality disorders manifest distinct physiological responses to psychosocial stress.. Psychoneuroendocrinology 2016; 72: 131-8.
  • 16 Nater UM, Bohus M, Abbruzzese E, Ditzen B, Gaab J, Kleindienst N. et al. Increased psychological and attenuated cortisol and alpha-amylase responses to acute psychosocial stress in female patients with borderline personality disorder.. Psychoneuroendocrinology 2010; 35 (10) 1565-72.
  • 17 Deckers JWM, Lobbestael J, van Wingen GA, Kessels RPC, Arntz A, Egger JIM. The influence of stress on social cognition in patients with borderline personality disorder.. Psychoneuroendocrinology 2015; 52 (01) 119-29.
  • 18 Inoue A, Oshita H, Maruyama Y, Tanaka Y, Ishitobi Y, Kawano A. et al. Gender determines cortisol and alpha-amylase responses to acute physical and psychosocial stress in patients with borderline personality disorder.. Psychiatry Res 2015; 228 (01) 46-52.
  • 19 Scott LN, Levy KN, Granger DA. Biobehavioral reactivity to social evaluative stress in women with borderline personality disorder.. Personal Disord Theory, Res Treat 2013; 4 (02) 91-100.
  • 20 Lyons-Ruth K, Choi-Kain L, Pechtel P, Bertha E, Gunderson J. Perceived parental protection and cortisol responses among young females with borderline personality disorder and controls.. Psychiatry Res 2011; 189 (03) 426-32.
  • 21 Pagano ME, Skodol AE, Stout RL, Shea MT, Yen S, Grilo CM. et al. Stressful life events as predictors of functioning: Findings from the Collaborative Longitudinal Personality Disorders Study.. Acta Psychiatr Scand 2004; 110 (06) 421-9.
  • 22 Lieb K, Zanarini M, Schmahl C, Linehan M. Borderline personality disorder.. Lancet 2004; 364: 453-61.
  • 23 Aguirre B. Handbook of Good Psychiatric Management for Borderline Personality Disorder.. J Psychiatr Pract 2015; 21 (04) 313-4.
  • 24 Kleindienst N, Bohus M, Ludäscher P, Limberger MF, Kuenkele K, Ebner-Priemer UW. et al. Motives for nonsuicidal self-injury among women with borderline personality disorder.. J Nerv Ment Dis 2008; 196 (03) 230-6.
  • 25 National Institute for Health and Care Excellence.. Borderline personality disorder: recognition and management CG78.. 2009; 1–40.
  • 26 Domes G, Schulze L, Herpertz SC. Emotion Recognition in Borderline Personality Disorder – A Review of the Literature.. J Pers Disord 2009; 23 (01) 6-19.
  • 27 Linehan MM, Bohus M, Lynch TR. Dialectical behavior therapy for pervasive emotion dysregulation: Theoretical and practical underpinnings.. In: Handbook of Emotion Regulation 2007: 581-605.
  • 28 Carvalho Fernando S. et al. The Impact of Self-Reported Childhood Trauma on Emotion Regulation in Borderline Personality Disorder and Major Depression.. J Trauma Dissociation 2014; 15 (04) 384-401.
  • 29 Bowlby J. Attachment and loss.. The International Psycho-Analytical Library 1969: 1-401.
  • 30 Scott LN, Yookyung K, Nolf KA, Hallquist MM, Wright AGC, Stepp SD. et al. Preoccupied Attachment and emotional dysregulation: Specific aspects of Borderline disorder or general dimensions of personality pathology.. Emot Rev 2013; 5 (02) 223-4.
  • 31 Fonagy P, Luyten P, Strathearn L. Borderline personality disorder, mentalization, and the neurobiology of attachment.. Infant Ment Health J 2011; 32 (01) 47-69.
  • 32 Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder.. World Psychiatry 2010; 9 (01) 11-5.
  • 33 Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF. Attachment and borderline personality disorder: Implications for psychotherapy.. Psycho-pathology 2005; 38(2).
  • 34 Fonagy P, Bateman A. The Development of Borderline Personality Disorder – A Mentalizing Model.. J Pers Disord 2008; 22 (01) 4-21.
  • 35 Ulrich-Lai YM, Herman JP. Neural regulation of endocrine and autonomic stress responses.. Nat Rev Neurosci 2009; 10 (06) 397-409.
  • 36 Shirtcliff EA, Peres JC, Dismukes AR, Lee Y, Phan JM. Hormones: Commentary: Riding the Physiological Roller Coaster: Adaptive Significance of Cortisol Stress Reactivity to Social Contexts.. J Pers Disord 2014; 28 (01) 40-51.
  • 37 Papadimitriou A, Priftis KN. Regulation of the Hypothalamic- Pituitary-Adrenal Axis.. Neuroimmunomodulation 2009; 16: 265-71.
  • 38 Shirtcliff EA. et al. A dual-axis approach to understanding neuroendocrine development.. Dev Psychobiol 2015; 57 (06) 643-53.
  • 39 McEwen BS. Protective and damaging effects of stress mediators.. Library 1998; 338 (03) 171-9.
  • 40 Kirschbaum C, Pirke KM, Hellhammer DH. The “Trier Social Stress Test” – a tool for investigating psychobiological stress responses in a labor atory setting.. Neuropsychobioloy 1993; 28: 76-81.
  • 41 Kobak RR. et al. Attachment and Emotion Regulation during other Teen Problem Solving: A Control Theory Analysis.. Child Dev 1993; 64 (01) 231-45.
  • 42 Kobak R, Zajac K, Levine S. Cortisol and antisocial behavior in early adolescence: The role of gender in an economically disadvantaged sample.. Dev Psychopathol 2009; 21 (02) 579-91.
  • 43 Klimes-Dougan B, Hastings PD, Granger D, Usher B, Zahn-Waxler C. Adrenocortical activity in at-risk and normally developing adolescents: individual differences in salivary cortisol basal levels, diurnal variation, and responses to social challenges.. Dev Psychopathol 2001; 13 (03) 695-719.
  • 44 Sánchez M. et al. Alterations in diurnal cortisol rhythm and acoustic startle response in nonhuman primates with adverse rearing.. Biol Psychiatry 2005; 57 (04) 373-81.
  • 45 Carpenter LL. et al. Effect of Childhood Emotional Abuse and Age on Cortisol Responsivity in Adulthood.. Biol Psychiatry 2009; 66 (01) 69-75.
  • 46 Bouchard S, Sabourin S. Borderline Personality Disorder and Couple Dysfunctions.. Current Psychiatry Reports 2009; 11 (01) 55-62.