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Fortschr Neurol Psychiatr 2001; 69(8): 379-387
DOI: 10.1055/s-2001-16511
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

Persönlichkeitsstörungen und psychiatrische Komorbidität im Verlauf der Zwangsstörung und der Anorexia nervosa

Vergleich zweier 10-Jahres-KatamnesenPersonality Disorders and Psychiatric Comorbidity in the Course of Obsessive-Compulsive Disorder and Anorexia NervosaB. Müller1 , C. Wewetzer3 , T. Jans3 , K. Holtkamp1 , S. C. Herpertz2 , A. Warnke3 , H. Remschmidt4 , B. Herpertz-Dahlmann1
  • 1Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum Rheinisch-Westfälische Technische Hochschule Aachen (Direktorin: Prof. Dr. B. Herpertz-Dahlmann)
  • 2Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Rheinisch-Westfälische Technische Hochschule Aachen (Komm. Direktor: Prof. Dr. Dr. P. Hoff)
  • 3Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Julius-Maximilians-Universität Würzburg (Direktor: Prof. Dr. A. Warnke)
  • 4Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Philipps-Universität Marburg (Direktor: Prof. Dr. Dr. H. Remschmidt)
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Publication History

Publication Date:
20 August 2001 (online)

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Zusammenfassung:

Es war das Ziel der vorliegenden Studie, den Verlauf der Anorexia nervosa und der Zwangsstörung bei adoleszenten Patienten zu untersuchen und einen Vergleich zwischen komorbiden psychiatrischen Erkrankungen und Persönlichkeitsstörungen durchzuführen. Da die Anorexia nervosa vorwiegend weibliche Patienten betrifft, wurde auch die Vergleichsstudie nur mit weiblichen zwangskranken Patienten durchgeführt. Zehn Jahre nach Entlassung konnten von 39 ehemaligen Anorexia-nervosa-Patienten (32 Mädchen und 7 Jungen), alle 32 (100 %) weiblichen Patienten nachuntersucht werden. Von den 116 ehemaligen Patienten mit Zwangsstörung (41 Mädchen und 75 Jungen), konnten 25 (61 %) weibliche Patienten nachuntersucht werden. Zur Erfassung der Essstörungssymptomatik der Anorexia-nervosa-Patienten wurde das Standardisierte Interview für Anorexia und Bulimia nervosa (SIAB [39]) verwandt, das Composite International Diagnostic Interview [44] für die Diagnostik der psychiatrischen (Ko-)Morbidität und das Strukturierte Klinische Interview für Persönlichkeitsstörungen (SKID-II [45]). Zum Zeitpunkt der Nachuntersuchung wurden bei einem Viertel der Patienten mit Anorexia nervosa (AN) und bei 20 % der Patienten mit Zwangsstörung (ZS) Persönlichkeitsstörungen, vorwiegend aus dem zwanghaft-ängstlich-vermeidenden Formenkreis des DSM-III-R diagnostiziert (AN: 28 %; ZS: 20 %). Zusätzlich traten in der Gruppe der Zwangskranken 8 % schizoide, 4 % schizotype und 12 % paranoide Persönlichkeitsstörungen auf. An psychiatrischen Diagnosen wurden in beiden Gruppen vorwiegend Angststörungen (AN: 28 %; ZS: 20 %) und affektive Erkrankungen (AN: 16 %; ZS: 16 %) diagnostiziert. Unsere Ergebnisse lassen sich in ein Ätiologiemodell integrieren, welches von einer gemeinsamen Vulnerabilität des serotoninergen Neurotransmittersystems bei der Anorexia nervosa und der Zwangsstörung ausgeht.

Personality Disorders and Psychiatric Comorbidity in the Course of Obsessive-Compulsive Disorder and Anorexia Nervosa:

The aim of this prospective longitudinal study was to examine the course of adolescent anorexia nervosa and obsessive-compulsive disorder (OCD) (fullfilling DSM-III-R criteria) to compare psychiatric comorbidity and personality disorders of both groups. Because anorexia nervosa patients are mainly female, we compared them only with female OCD patients. Ten years after discharge the whole sample (32 female patients; 100 %) of a group of 39 (32 female; 7 male) anorexia nervosa patients could be reexamined personally. 25 (61 %) female patients of a group of 116 patients (41 female; 75male) with obsessive-compulsive disorder were also reexamined. The anorexia nervosa patients were interviewed using the Structured Interview for Anorexia and Bulimia nervosa (SIAB [39]) to assess eating disorder symptomatology. To examine comorbid psychiatric disorders we used the Composite International Diagnostic Interview, WHO [44] and SCID-II [45] for personality disorders. One fourth of the patients with anorexia nervosa (AN) and 20 % of the patients with obsessive-compulsive disorder had a personality disorder according to DSM-III-R. Most of them were “Cluster C”-personality disorders (AN: 28 %; OCD: 20 %). In the group of the female OCD patients 8 % schizoid, 4 % schizotype and 12 % paranoid personality disorders were observed. The most prevalent psychiatric disorders were anxiety (AN: 28 %; OCD: 20 %) and affective disorders (AN: 16 %; OCD: 16 %). Our results support the view that in the course of anorexia nervosa and in obsessive-compulsive disorder there is a high prevalence of psychiatric comorbidity and “Cluster C”-personality disorders according to DSM-III-R. These results might confirm a model of a high vulnerability of the serotonergic neurotransmitter system in patients with anorexia nervosa or OCD.

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Dr. med. Bodo Müller

Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie
Universitätsklinikum Rheinisch-Westfälische Technische Hochschule Aachen

Neuenhofer Weg 21

52074 Aachen

Email: E-mail: bodo.mueller@kjp.rwth-aachen.de