Schwierigkeiten der Emotionsregulation bei alkoholabhängigen Patienten mit komorbiden posttraumatischen Belastungsstörungen

Zusammenfassung

Ziel Das Ziel dieser Studie war es, Schwierigkeiten der Emotionsregulation bei alkoholabhängigen Patienten mit komorbider komplexer posttraumatischer Belastungsstörung (KPTBS) im Vergleich zu alkoholabhängigen Patienten mit komorbider posttraumatischer Belastungsstörung (PTBS) zu vergleichen.

Methodik N=106 Patienten mit Alkoholabhängigkeit und komorbider posttraumatischer Belastungsstörung nach DSM-5 wurden in die Studie eingeschlossen. Die Diagnose einer KPTBS wurde anhand des Interviews zur Erfassung der komplexen Posttraumatischen Belastungsstörung erhoben, Schwierigkeiten der Emotionsregulation wurden mit der Difficulties in Emotion Regulation Scale erfasst.

Ergebnisse Patienten mit komorbider KPTBS als auch Patienten mit komorbider PTBS wiesen Schwierigkeiten der Emotionsregulation auf. Schwierigkeiten der Emotionsregulation nahmen mit zunehmender Schwere der posttraumatischen Belastungsstörung zu. Patienten mit komorbider KPTBS wiesen im Vergleich zu Patienten mit komorbider PTBS größere Schwierigkeiten im Bereich der Aufmerksamkeit für die eigenen Emotionen auf.

Schlussfolgerung Schwierigkeiten der Emotionsregulation sollten in der Behandlung von Patienten mit Alkoholabhängigkeit und komorbider posttraumatischer Belastungsstörung berücksichtigt werden. Bei Patienten mit KPTBS sollte die Aufmerksamkeit für die eigenen Emotionen besonders geschult werden.

Abstract

Aim The aim of this study was to examine difficulties in emotion regulation in alcohol dependent patients with comorbid complex posttraumatic stress disorder (CPTSD) compared to alcohol dependent patients with comorbid posttraumatic stress disorder (PTSD).

Method N=106 patients with alcohol dependence and comorbid PTSD according to DSM-5 were included in the study. Diagnosis of CPTSD was assessed by the Interview for Assessing CPTSD, difficulties in emotion regulation were measured with the Difficulties in Emotion Regulation Scale.

Results Patients with comorbid CPTSD as well as patients with comorbid PTSD showed difficulties in emotion regulation. Difficulties in emotion regulation increased with increasing severity of PTSD. Patients with comorbid CPTSD showed greater difficulties in the domain of attention to one’s own emotions, compared with patients with comorbid PTSD.

Conclusion Difficulties in emotion regulation should be addressed in the treatment of patients with alcohol dependence and comorbid posttraumatic stress disorder. For patients with CPTSD, the ability to attend to one’s own emotions should be trained.

Schlüsselwörter

Emotionsregulation - komplexe posttraumatische Belastungsstörung - körperliche Gewalt - sexueller Missbrauch - Suchterkrankung

Key words

Emotion regulation - complex posttraumatic stress disorder - physical abuse - sexual abuse - addiction

• Literatur

• 1 Beutel M. Sucht und sexueller Missbrauch. Psychotherapeut 1999; 44: 313-319
• 2 Kuhn S. Trauma, Posttraumatische Belastungsstörung und Substanzabhängigkeit: Eine Literaturübersicht. Suchttherapie 2004; 5: 110-117
• 3 Teegen F, Zumbeck S. Prävalenz traumatischer Erfahrungen und Posttraumatischer Belastungsstörung bei substanzabhängigen Personen. Psychotherapeut 2000; 45: 44-49
• 4 Hellmer I. Trauma, Posttraumatische Belastungsstörung (PTBS) und Substanzabhängigkeit. Wien Z Für Suchtforsch 2009; 32: 5-12
• 5 Brady KT, Back SE, Coffey SF. Substance abuse and posttraumatic stress disorder. Curr Dir Psychol Sci 2004; 1 13: 206-209
• 6 O’Bryan EM, McLeish AC, Kraemer KM. et al. Emotion regulation difficulties and posttraumatic stress disorder symptom cluster severity among trauma-exposed college students. Psychol Trauma Theory Res Pract Policy 2015; 7: 131-137
• 7 Tull MT, Barrett HM, McMillan ES. et al. A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behav Ther 2007; 38: 303-313
• 8 Gross JJ. The emerging field of emotion regulation: An integrative review. Rev Gen Psychol 1998; 2: 271-299
• 9 Thompson RA. Emotion regulation: A theme in research of definition. Monogr Soc Res Child Dev 1994; 59: 25-52
• 10 John OP, Gross JJ. Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. J Pers 2004; 72: 1301-1334
• 11 McLaughlin KA, Hatzenbuehler ML, Mennin DS. et al. Emotion dysregulation and adolescent psychopathology: A prospective study. Behav Res Ther 2011; 1 49: 544-554
• 12 Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev 2010; 30: 217-237
• 13 Werner K, Gross JJ. Emotion regulation and psychopathology: A conceptual framework. In: Kring AM, Sloan DM. editors. Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment. New York, NY: Guilford Press; 2010: 13-37
• 14 Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 2004; 26: 41-54
• 15 Luxenberg T, Spinazzola J, Van der Kolk BA. Complex trauma and disorders of extreme stress (DESNOS) diagnosis, part one: Assessment. Dir Psychiatry 2001; 21: 373-392
• 16 Ehring T, Quack D. Emotion regulation difficulties in trauma survivors: The role of trauma type and PTSD symptom severity. Behav Ther 2010; 41: 587-598
• 17 Powers A, Cross D, Fani N. et al. PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample. J Psychiatr Res 2015; 61: 174-179
• 18 Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry 1997; 4: 231-244
• 19 Moggi F, Donati R. Psychische Störungen und Sucht: Doppeldiagnosen. Göttingen: Hogrefe; 2003
• 20 Schäfer I, Barnow S, Pawils S. CANSAS Study Group . Substanzbezogene Störungen als Ursache und als Folge früher Gewalt. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2016; 59: 35-43
• 21 Bradley B, DeFife JA, Guarnaccia C. et al. Emotion dysregulation and negative affect: Association with psychiatric symptoms. J Clin Psychiatry 2011; 72: 685-691
• 22 McDermott MJ, Tull MT, Gratz KL. et al. The role of anxiety sensitivity and difficulties in emotion regulation in posttraumatic stress disorder among crack/cocaine dependent patients in residential substance abuse treatment. J Anxiety Disord 2009; 23: 591-599
• 23 Weiss NH, Tull MT, Anestis MD. et al. The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients. Drug Alcohol Depend 2013; 128: 45-51
• 24 Weiss NH, Tull MT, Viana AG. et al. Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. J Anxiety Disord 2012; 26: 453-458
• 25 van der Kolk BA. Developmental trauma disorder: towards a rational diagnosis for chronically traumatized children. Prax Kinderpsychol Kinderpsychiatr 2008; 58: 572-586
• 26 van der Kolk BA, Roth S, Pelcovitz D. et al. Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. J Trauma Stress 2005; 18: 389-399
• 27 Maercker A, Brewin CR, Bryant RA. et al. Diagnosis and classification of disorders specifically associated with stress: Proposals for ICD-11. World Psychiatry 2013; 12: 198-206
• 28 Pelcovitz D, van der Kolk B, Roth S. et al. Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). J Trauma Stress 1997; 10: 3-16
• 29 Sack M. Diagnostische und klinische Aspekte der komplexen posttraumatischen Belastungsstörung. Nervenarzt 2004; 75: 451-459
• 30 Driessen M, Beblo T, Reddemann L. et al. Ist die Borderline-Persönlichkeitsstörung eine komplexe posttraumatische Störung? Zum Stand der Forschung. Nervenarzt 2002; 73: 820-829
• 31 American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association; 2013
• 32 Shelby RA, Golden-Kreutz DM, Andersen BL. PTSD diagnoses, subsyndromal symptoms, and comorbidities contribute to impairments for breast cancer survivors. J Trauma Stress 2008; 21: 165-172
• 33 Hiller W, Zaudig M, Mombour W. Internationale Diagnosen Checklisten (IDCL) für DSM-IV. Göttingen: Hogrefe; 1997
• 34 Hiller W, Zaudig M, Mombour W. Development of diagnostic checklists for use in routine clinical care: a guideline designed to assess DSM-III-R diagnoses. Arch Gen Psychiatry 1990; 47: 782-784
• 35 Hiller W, von Bose M, Dichtl G. et al. Reliability of checklist-guided diagnoses for DSM-IIIR affective and anxiety disorders. J Affect Disord 1990; 20: 235-247
• 36 Schnyder U. Clinician-Administered PTSD Scale for DSM-5 – Past month version. Zürich: UniversitätsSpital Zürich; 2013
• 37 Weathers FW, Keane TM, Davidson JR. Clinician-Administered PTSD Scale: A review of the first ten years of research. Depress Anxiety 2001; 13: 132-156
• 38 Weathers FW, Bovin MJ, Lee DJ. et al. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assessment Advance online publication doi:
• 39 Sack M, Hofmann A. Interview zur komplexen posttraumatischen Belastungsstörung (IK-PTBS). Hannover: 2001
• 40 Boroske-Leiner K, Hofmann A, Sack M. Ergebnisse zur internen und externen Validität des Interviews zur komplexen posttraumatischen Belastungsstörung (I-kPTBS). Psychother Psychosom Med Psychol 2008; 58: 192-199
• 41 Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess 2008; 30: 315-315
• 42 Schäfer I, Chuey-Ferrer L, Hofmann A. et al. Effectiveness of EMDR in patients with substance use disorder and comorbid PTSD: Study protocol for a randomized controlled trial. BMC Psychiatry 2017; 17: 95
• 43 Weiss NH, Tull MT, Dixon-Gordon KL. et al. Extending findings of a relation between posttraumatic stress disorder and emotion dysregulation among African American individuals: A preliminary examination of the moderating role of gender. J Trauma Stress Disord Treat 2013; 3: 1686
• 44 Dyer KFW, Dorahy MJ, Hamilton G. et al. Anger, aggression, and self-harm in PTSD and complex PTSD. J Clin Psychol 2009; 65: 1099-1114
• 45 Weiss NH, Tull MT, Lavender J. et al. Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers. Child Abuse Negl 2013; 37: 944-954
• 46 Gratz KL, Bornovalova MA, Delany-Brumsey A. et al. A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behav Ther 2007; 38: 256-268
• 47 Cloitre M, Stolbach BC, Herman JL. et al. A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress 2009; 22: 399-408
• 48 Lanius RA, Bluhm RL, Frewen PA. How understanding the neurobiology of complex post-traumatic stress disorder can inform clinical practice: a social cognitive and affective neuroscience approach. Acta Psychiatr Scand 2011; 124: 331-348
• 49 Marx BP, Sloan DM. The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse. Behav Ther 2002; 33: 563-577
• 50 Polusny MA, Rosenthal MZ, Aban I. et al. Experiential avoidance as a mediator of the effects of adolescent sexual victimization on negative adult outcomes. Violence Vict 2004; 19: 109-120
• 51 Lane RD, Schwartz GE. Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology. Am J Psychiatry 1987; 144: 133-143
• 52 Fonagy P, Gergely G, Jurist EL. Affect regulation, mentalization and the development of the self. London: Karnac books; 2004
• 53 Stern DN, Hofer L, Haft W. et al. Affect attunement: The sharing of feeling states between mother and infant by means of inter-modal fluency. In: Field TM, Fox NA. ed. Social perception in infants. Norwood, NJ: Ablex; 1985: 249-268
• 54 Cook A, Spinazzola J, Ford J. et al. Complex trauma. Psychiatr Ann 2005; 35: 390-398
• 55 Mandavia A, Robinson GGN, Bradley B. et al. Exposure to childhood abuse and later substance use: Indirect effects of emotion dysregulation and exposure to trauma. J Trauma Stress 2016; 29: 422-429
• 56 Cloitre M, Scarvalone P, Difede J. Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women. J Trauma Stress 1997; 10: 437-452
• 57 van der Kolk BA, Pelcovitz D, Roth S. et al Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. Am J Psychiatry 1996; 153 7 Suppl 83-93
• 58 Harrison PA, Fulkerson JA, Beebe TJ. Multiple substance use among adolescent physical and sexual abuse victims. Child Abuse Negl 1997; 21: 529-539
• 59 Craparo G, Ardino V, Gori A. et al. The Relationships between early trauma, dissociation, and alexithymia in alcohol addiction. Psychiatry Investig 2014; 11: 330-335
• 60 Handelsman L, Stein JA, Bernstein DP. et al. A latent variable analysis of coexisting emotional deficits in substance abusers: Alexithymia, hostility, and PTSD. Addict Behav 2000; 25: 423-428
• 61 Fox HC, Hong KA, Sinha R. Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers. Addict Behav 2008; 33: 388-394
• 62 Teegen F, Schriefer J. Komplexe Posttraumatische Belastungsstörung: Eine Untersuchung des diagnostischen Konstruktes am Beispiel misshandelter Frauen. Z Für Klin Psychol Psychiatr Psychother 2002; 50: 219-233
• 63 Dorn C, Spindler G, Kullik A. et al. Erfassung von Emotionsregulationsstrategien – eine Übersicht. Psychol Rundsch 2013; 64: 217-227
• 64 Ebert DD, Christ O, Berking M. Entwicklung und Validierung eines Fragebogens zur emotionsspezifischen Selbsteinschätzung emotionaler Kompetenzen (SEK-ES). Diagnostica 2013; 59: 17-32
• 65 Glenn CR, Klonsky ED. Emotion dysregulation as a core feature of Borderline Personality Disorder. J Personal Disord 2009; 23: 20-28
• 66 Frewen PA, Dozois DJ, Neufeld RW. et al. Meta-analysis of alexithymia in posttraumatic stress disorder. J Trauma Stress 2008; 21: 243-246
• 67 Bohus M, Dyer AS, Priebe K. et al. Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial. Psychother Psychosom 2013; 82: 221-233
• 68 Ehring T, Welboren R, Morina N. et al. Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clin Psychol Rev 2014; 34: 645-657
• 69 Cloitre M, Koenen KC, Cohen LR. et al. Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. J Consult Clin Psychol 2002; 70: 1067-1074
• 70 Cloitre M, Stovall-McClough KC, Nooner K. et al. Treatment for PTSD related to childhood abuse: A randomized controlled trial. Am J Psychiatry 2010; 167: 915-924