Das entfremdete Selbst, die entfremdete Umwelt

ZUSAMMENFASSUNG

Obwohl Dissoziation einer der ältesten Forschungsgegenstände der Psychiatrie darstellt, bleibt sie bis heute ein vage definiertes und mannigfaltiges Konstrukt. Ausgeprägte dissoziative Symptome sind für eine Subgruppe von Patienten mit Borderline-Persönlichkeitsstörung (BPS) und posttraumatischer Belastungsstörung (PTBS) charakteristisch und von hoher klinischer Relevanz mit Prävalenzen von 19–34 % bei BPS und bis zu 60 % bei PTBS. Insbesondere Veränderungen der psychischen Integrität mit einer Entfremdung von Selbst und Umwelt (Derealisation/Depersonalisation) gehen mit einer ausgeprägteren BPS- und PTBS-Symptomatik sowie riskanten Verhaltensweisen wie Selbstverletzung und Suizidalität einher. Dissoziative Symptome können nach dem aktuellen Kenntnisstand als eine unwillkürliche und automatische maladaptive Form der Emotionsregulation eingestuft werden, bei welcher subjektiv eine Distanz zu internalen oder externalen bedrohlichen Ereignissen hergestellt wird, die aber objektiv mit einer erhöhten Stressreaktion und autonomer Erregung aufzutreten scheint. Insbesondere bei der BPS wirken sich dissoziative Symptome negativ auf das Behandlungsergebnis aus, während die konkrete Adressierung von Dissoziationen beispielsweise durch Psychoedukation, Achtsamkeit oder Fertigkeitentraining Therapieerfolge verbessert.

ABSTRACT

Although dissociations are one of the oldest subjects of research in psychiatry, they remain a vaguely defined and multifaceted construct. Pronounced dissociative symptoms a hallmark of a subgroup of patients with borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) with rates of 19–34 % in BPD and up to 60 % in PTSD. Dissociations are of high clinical relevance as they manifest with diverse adverse health consequences. In particular, changes in the psychological integrity with alienation from self and environment (derealization/depersonalization) are associated with more pronounced BPD and PTSD symptomatology, as well as risky behaviors such as self-harm and suicidality. Derealization/depersonalization can be classified, according to current knowledge, as an involuntary and automatic maladaptive form of emotion regulation by which a distance from internal or external threatening events is established, but seems to be accompanied by an increased stress response and autonomic arousal. In patients with BPD, dissociative symptoms predict lower treatment success while addressing dissociative symptoms directly in therapy by psychoeducation, teaching mindfulness and other skills improves the results.

Schlüsselwörter

Dissoziationen - Derealisation - Depersonalisation - Borderline-Persönlichkeitsstörung - posttraumatische Belastungsstörung

Key words

Dissociation - derealisation - depersonalisation - borderline personality disorder - post-traumatic stress disorder

Publikationsverlauf

Artikel online veröffentlicht:
03. März 2023

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