Endokrinologische Korrelate der Borderline-Persönlichkeitsstörung

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.

Schlüsselwörter:

Borderline-Persönlichkeitsstörung - Kortisol - HPA - interpersonelle Stressoren - soziale Stressoren - Trier Social Stress Test

Keywords

Borderline-Personality Disorder - cortisol - HPA - interpersonal stressor - social stressor - Trier Sozialer Stress Test

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