Christian Stiglmayr

Evaluation of inpatient Dialectical-Behavioral Therapy for Borderline Personality Disorder — a prospective study

Dialectical-Behavioral Therapy for Borderline Personality Disorder (DBT) developed by M. Linehan is specifically designed for the outpatient treatment of chronically suicidal patients with borderline personality disorder. Research on DBT therapy, its course and its results has focused to date on treatments in an outpatient setting. Hypothesizing that the course of therapy could be accelerated and improved by an inpatient setting at the beginning of outpatient DBT, we developed a treatment program of inpatient therapy for this patient group according to the guidelines of DBT. It consists of a three-month inpatient treatment prior to long-term outpatient therapy. In this pilot study 24 female patients were compared at admission to the hospital, and at one month after discharge with respect to psychopathology and frequency of self-injuries. Significant improvements in ratings of depression, dissociation, anxiety and global stress were found. A highly significant decrease in the number of parasuicidal acts was also reported. Analysis of the average effect sizes shows a strong effect which prompts the development of a randomized controlled design.

Aversive tension in patients with borderline personality disorder: a computer‐based controlled field study

Objective:  This study was designed to examine the subjective appraisal of aversive tension under conditions of daily life in patients with borderline personality disorder (BPD).

Experience of aversive tension and dissociation in female patients with borderline personality disorder — a controlled study

Assuming that the experience of strong aversive tension might be an indicator of the extent of affect dysregulation within patients with borderline personality disorder (BPD), we sought to operationalize the duration and intensity of these phenomena. In addition we studied the relationship between aversive tension and the experience of dissociative features. Seventy-two female patients with BPD, together with 55 healthy controls, completed a self-rating questionnaire covering the previous 24 h. Substantial and highly significant differences with regard to the duration and intensity of the subjectively perceived states of aversive tension were found. Amongst patients with BPD there was a strong correlation between duration and intensity of tension, and experience of dissociative features, both somatoform and psychological. The findings underline the clinical importance of states of aversive tension in BPD particularly with regard to stress-related induction of dissociative features.

Dissociative symptoms are positively related to stress in borderline personality disorder

Objective:  According to DSM‐IV criteria, dissociative symptoms in borderline personality disorder (BPD) occur in response to stress. Empirical evidence is, however, lacking.

Emotion identification and tension in female patients with borderline personality disorder

OBJECTIVES This study investigates the identification of emotions in patients with borderline personality disorder (BPD), when compared with mentally healthy control subjects. The inability to identify different emotions is considered as an essential component of affect dysregulation in BPD that has rarely been empirically investigated. METHODS In this study, 30 female borderline patients and 28 healthy control participants received a handheld-PC for a 24-hour period that reminded them hourly to enter data. RESULTS When compared with the control group, patients showed pronounced difficulties in emotion identification. Moreover, the data revealed a significant relationship between difficulties in identifying emotions and levels of aversive inner tension for BPD patients, but not for control subjects. CONCLUSIONS Results indicate that the inability to identify different emotions is a problem that characterizes borderline patients in real-life situations. Treatment programs should, therefore, focus on the improvement of emotion identification and regulation.

Development and Psychometric Characteristics of the DSS-4 as a Short Instrument to Assess Dissociative Experience during Neuropsychological Experiments

Background/Aims: Until now, no brief self-report instrument for the assessment of dissociative states comprising somatoform and psychological items has been available. Thus, we developed a brief instrument for repeated assessment of dissociation during single neuropsychological experiments and neuroimaging. Methods: Based on specific criteria, 4 items were derived from an already existing scale for the assessment of dissociative symptoms (Dissociation-Tension Scale acute, DSS-acute). These 4 items were presented to a total of 142 female patients with different disorders and healthy controls every hour over a 48-hour period. Data acquisition was done with a handheld PC. Results: Inner consistency, reliability and differential validity can be considered to be good or excellent. The DSS-4 was sensitive to changing symptomatology within the 48-hour period and additionally within a 3-hour period. Conclusion: Taken together, our newly developed instrument provides a reliable and easy-to-use tool for the assessment of psychological and somatic aspects of dissociative states, for example for the use at multiple times during single neuropsychological experiments or neuroimaging. There are some indicators that the DSS-4 is a valid instrument.

Development and Psychometric Characteristics of the Dissociation Tension Scale

The newly developed Dissoziations-Spannungs-Skala (Dissociation Tension Scale; DSS) is a self-rating instrument for the assessment of psychological and somatoform dissociative features (ranging from normal up to pathological) as well as aversive inner tension occurring within the past 7 days. The DSS contains 21 items assessing dissociative symptoms and 1 additional item assessing aversive inner tension. Ratings are made on a time-oriented scale ranging from 0% (never) to 100% (constantly). We measured the psychometric qualities of the DSS in a total of 294 patients and healthy controls. Internal consistency of the DSS was high (Cronbachs α = .92; Gutmanns split-half r = .92). We found good support for convergent, discriminant, and differential validity. There was clear evidence for the DSS being a sensitive instrument for the assessment of changing symptomatology. Assessment of dissociation and other psychopathological features over the same period of time are now possible.

Dialektisch Behaviorale Therapie (DBT) und Kognitiv Behaviorale Therapie (CBT) für Jugendliche mit Anorexia und Bulimia nervosa im Vergleich

Ziel der vorliegenden randomisierten kontrollierten Studie war die Uberprufung der Wirksamkeit der Kognitiv Behavioralen Therapie (CBT) sowie der Dialektisch Behavioralen Therapie (DBT-AN/BN) bei Patienten mit einer Anorexia nervosa (AN) und Bulimia nervosa (BN). 50 weibliche Patienten (12;4 – 21;0 Jahre) nahmen an der Untersuchung teil. 19 Patientinnen absolvierten eine 25-wochige CBT, 16 eine 25-wochige DBT-AN/BN und 15 wurden fur 3 Monate einer Wartekontrollgruppe (WKG) zugeordnet. Am Ende der Behandlung erfullten in der CBT-Gruppe noch 42.1 %, in der DBT-AN/BN-Gruppe 37.5 % und in der WKG alle Patienten die Kriterien einer Essstorung nach DSM-IV. Sowohl die CBT als auch die DBT-AN/BN fuhrten verglichen mit der WKG zu einer Reduktion der Kalorienvermeidung, der unregelmasigen Nahrungsaufnahme und der aktuellen psychischen Belastung sowie zu einer Erhohung des BMI. Bezogen auf die Korperbildstorung, die Autonomieentwicklung, die Emotionsregulation sowie den Perfektionismus konnten nur geringe positive E...

Klassifikation und Phänomenologie

Sowohl die ICD-10 als auch das DSM-5 verstehen unter Dissoziation einen psychophysiologischen Prozess, dessen wesentlichstes Charakteristikum in einer Desintegration der normalerweise integrativen Funktionen des Bewusstseins, des Gedachtnisses, der Identitat, der Wahrnehmung der Umwelt sowie der Sensorik, Sensibilitat und Motorik besteht. Absorptionsphanomene sowie Gefuhle von Losgelostheit und Taubheit gelten als „normale“, nicht pathologische Dissoziation. Andere dissoziative Zustande treten vorrangig in Extremsituationen auf, allen voran Amnesie, Depersonalisations- und Derealisationsphanomene sowie Veranderungen in der Identitat. Die Lebenszeitpravalenz fur schwerwiegende dissoziative Symptome liegt in der Allgemeinbevolkerung bei ca. 3 %, in klinischen Populationen zwischen 14 und 30 %. Nicht pathologische dissoziative Phanomene kommen in der Allgemeinbevolkerung bei nahezu 100 % der Befragten vor.

Borderline-Persönlichkeitsstörung und andere Persönlichkeitsstörungen

Dissoziative Symptome wie auch dissoziative Storungen treten bei Patienten mit einer Borderline-Personlichkeitsstorung (BPS) sehr haufig auf. Betroffen ist das gesamte Ausmas an dissoziativer Symptomatik, wobei Depersonalisations- und Derealisationsphanomene sowie die Abwesenheit von Gefuhlen am haufigsten vorkommen. Bei Borderlinepatienten mit selbstverletzenden Verhaltensweisen finden sich deutlich erhohte Dissoziationswerte. Fur das Auftreten dissoziativer Zustande ist die Diagnose einer BPS eine ausreichende Bedingung. Traumatische Erlebnisse stellen einen moderierenden, zusatzlichen Risikofaktor dar, wobei die Starke der dissoziativen Problematik mit der Schwere der Traumatisierungen positiv korreliert. Patienten mit einer anderen Personlichkeitsstorung erreichen im Vergleich zu Patienten mit einer BPS deutlich geringere Dissoziationswerte.