Subscribe to RSS
Download PDF
DOI: 10.1055/s-0038-1628810
Umgang mit selbstverletzendem Verhalten, Suizidalität und manipulativer Suizidalität
Stationäre Behandlung von Patientinnen mit Borderline-PersönlichkeitsstörungManagement of deliberate self-harm, suicidal tendency, and manipulative suicidal tendency duringIn-patient treatment of patients with borderline personality disorderPublication History
Eingegangen am:
25 August 2009
angenommen am:
25 August 2009
Publication Date:
24 January 2018 (online)
Zusammenfassung
Selbstverletzendes Verhalten ist bei Patientinnen mit Borderline-Persönlichkeitsstörung häufig und kann viele psychische, soziale und zum Teil auch neurobiologische Funktionen erfüllen. Suizidversuche sind ebenfalls häufig und indizieren ein erhöhtes Suizidrisiko. Bis zu 10% der Patientinnen versterben an Suizid, der Anteil an allen Suiziden wird zwischen 9 und 33% geschätzt. Suizidalität ist deshalb der typische Einweisungsgrund für eine stationäre Behandlung. Trotz des im Langzeitverlauf erhöhten Suizidrisikos muss die Indikation für eine stationäre Behandlung kritisch beurteilt werden. Regressive Tendenzen mit manipulativer Suizidalität, gehäuften Selbstverletzungen und Abgabe von Selbstverantwortung werden gefördert, wenn es nicht gelingt, eine Behandlungsstrategie zur Stärkung der Eigenverantwortung zu etablieren. Diesbezügliche Empfehlungen werden aus den klinischen Erfahrungen einer Kriseninterventionsstation abgeleitet.
Summary
Self-harm is by definition frequent among patients with borderline personality disorder. It has various mental, social, and even neurobiological functions. Suicide attempts are frequent and indicate an increased suicide risk. Up to 10% of patients die from suicide, the percentage among all suicides is estimated between 9 and 33%. Therefore suicidal tendency is a typical reason for admission. Despite the elevated long-term suicide risk, hospital admission and length of stay have to be discussed critically, since evidence for its benefit is scarce. Hospitalisation can promote regressive tendencies with “manipulative” suicidal behaviour, increasing acts of selfharm and delegation of self-responsibility. A strategy for the strengthening of individual responsibility is required. Recommendations are given from the experiences of a crisis intervention ward.
-
Literatur
- 1 American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed.) (DSM-IV). Washington DC: American Psychiatric Press; 1994
- 2 American Psychiatric Association. Practice Guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry. 2003 160. (Nov suppl.).
- 3 Bellino S, Paradiso E, Bogetto F. Efficacy and tolerability of pharmacotherapies for borderline personality disorder. CNS Drugs 2008; 02: 671-692.
- 4 Bohus M. et al. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004; 42 (05) 487-99.
- 5 Dubo ED. et al. Childhood antecedents of self-destructiveness in borderline personality disorder. Can J Psychiatry 1997; 42: 63-69.
- 6 Dulit RA. et al. Clinical correlates of self-mutilation in borderline personality disorder. Am J Psychiatry 1994; 151: 1305-1311.
- 7 Grant BF. et al. 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 (04) 533-45.
- 8 Gunderson JG, Ridolfi ME. Borderline personality disorder. Suicidality and self-mutilation. Ann New York Acad Sci 2001; 932: 61-73.
- 9 Hübner-Liebermann B, Hajak G, Spiessl H. Versorgungsepidemiologie: Entwicklung in der stationärpsychiatrischen Versorgung 1996-2006. Psychiat Prax 2008; 35: 387-391.
- 10 Kallert TW, Schützwohl M, Matthes C. Aktuelle Struktur-und Leistungsmerkmale allgemeinpsychiatrischer Tageskliniken in der Bundesrepublik Deutschland. Psychiat Prax 2003; 30: 72-82.
- 11 Mc Girr A. et al. Risk factors for suicide completion in borderline personality disorder: A case-control study of cluster B comorbidity and impulsive aggression. J Clin Psychiatry 2007; 68: 721-729.
- 12 Oldham J. Borderline personality disorder and suicidality. Am J Psychiatry 2006; 163: 20-25.
- 13 Oumava M. et al. Borderline personality disorder, self-mutilation and suicide: Literature review. L’Encéphale 2008; 34: 452-458.
- 14 Paris J, Nowlis D, Brown R. Predictors of suicide in borderline personality disorder. Can J Psychiatry 1989; 34: 8-9.
- 15 Paris J, Zweig FH. A 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry 2001; 42: 482-487.
- 16 Paris J. Chronic suicidality among patients with borderline personality disorder. Psychiatr Serv 2002; 53: 738-743.
- 17 Paris J. Is Hospitalization useful for suicidal patients with borderline personality disorder?. J Personality Dis 2004; 18: 240-247.
- 18 Pompili M, Girardi P, Ruberto A, Tatarelli R. Suicide in borderline personality disorder: a meta-analysis. Nord J Psychiatry 2005; 59: 319-324.
- 19 Schulz SC. et al. Olanzapine for the treatment of borderline personality disorder: variable dose 12-week ransomised double-blind placebo-controlled study. Br J Psychiatry 2008; 193: 485-492.
- 20 Soloff PH, Fabio A. Prospective predictors of suicide attempts in borderline personality disorder an one, two, and two-to-five year follow-up. J Personality Dis 2008; 22: 123-134.
- 21 Steinert T. et al. Successful interventions on an organisational level to reduce violence and coercive interventions in in-patients with adjustment disorders and personality disorders. Clin Pract Epid Ment Health 2008; 04: 27.
- 22 Steinert T. et al. Prozessund Ergebnisqualität in der Psychiatrie: Reduktion von Patientenübergriffen und Zwangsmaßnahmen bei Patienten mit Persönlichkeitsstörungen durch Implementation einer Kriseninterventionsstation. Gesundh ökon Qual manag 2009; 14: 44-48.
- 23 Tadicč A. et al. Gender Differences in Axis I and Axis II Comorbidity in Patients with Borderline Personality Disorder. Psychopathology 2009; 42 (04) 257-263.
- 24 Uhlmann C, Steinert T. Stationsatmosphäre und Behandlungserfolg nach Eröffnung einer Spezialstation für Patienten mit Persönlichkeitsstörungen und akuten Krisen. Verhaltenstherapie 2008; 18: 230-236.
- 25 Wolfersdorf M. Suizidalität. Nervenarzt 2008; 79: 1319-1336.
- 26 Zaheer J, Links PS, Liu E. Assessment and emergency management of suicidality in personality disorders. Psychiatr Clin N Am 2008; 31: 527-543.
- 27 Zanarini MC. et al. Axis I comorbidity in patients with borderline personality disorder: 6-year followup and prediction of time to remission. Am J Psychiatry 2004; 161: 2108-2114.
- 28 Zanarini MC. et al. Predictionof the 10-year course of borderline personality disorder. Am J Psychiatry 2006; 163: 827-832.
- 29 Zanarini MC. et al. Mental health service utilization by borderline personality disorder patients and axis II compatision subjectes followed prospectively for 6 years. J Clin Psychiatry 2004; 65: 28-36.
- 30 Zanarini MC, Frankenburg FR, Hennen J, Silk KR. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry 2003; 160: 274-283.
- 31 Zanarini MC. et al. The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatr Scand 2008; 117: 177-184.