Persönlichkeitsstörungen und Sucht

Zusammenfassung

In der Klinik kommen Suchterkrankungen bei Patient:innen mit Persönlichkeitsstörungen häufig vor. Bei etwa jeder zweiten Persönlichkeitsstörung kann eine komorbide Suchterkrankung diagnostiziert werden. Bei Patient:innen mit einer Drogenabhängigkeit scheint eine komorbide Persönlichkeitsstörung etwas häufiger als bei der Alkoholabhängigkeit aufzutreten. Eine besonders häufige Assoziation wurde zwischen Cluster-B-Persönlichkeitsstörungen (DSM-5) und einer komorbiden Suchterkrankung gefunden.

In der Behandlung der Komorbidität sollte der Grundsatz gelten, dass beide Störungsbilder beachtet und gemeinsam behandelt werden. Ist die Persönlichkeitsproblematik im Vordergrund, werden insbesondere störungsspezifische Psychotherapien mit Erfolg angewandt (z. B. Dialektisch-Behaviorale Therapie DBT, Übertragungsfokussierte Therapie TFP, Mentalisierungsbasierte Therapie MBT, Schematherapie). Ist die Suchtproblematik klinisch führend, kommen derzeit neben pharmakologischen Behandlungen vorrangig suchtspezifische Interventionen, wie die Motivierende Gesprächsführung oder die Rückfallprävention zum Einsatz. Bei evidenzbasierter Behandlung ist die Prognose wahrscheinlich günstiger als dies in Studien bisher berichtet wurde.

Abstract

Addictive disorders are common in patients with personality disorders. In about every second personality disorder, a comorbid substance use disorder can also be diagnosed. In patients with drug addiction, comorbid personality disorder seems to occur more frequently than in alcohol addiction. A particularly frequent association was found between Cluster-B personality disorder and a comorbid addictive disorder.

In the treatment of comorbidity, the principle should be that both disorders are considered and treated together. If the personality disorder is prominent, disorder-specific psychotherapies can be used successfully (e. g. Dialectical Behavior Therapy DBT, Transference-focused Psychotherapy TFP, Mentalization-Based-Treatment MBT, schema therapy). If the substance use disorder is dominant, addiction-specific interventions, such as motivational interviewing or relapse prevention, are to be used in addition to pharmacological treatments.

With evidence-based treatment, the prognosis is likely to be more favorable than has been reported in earlier studies.

Schlüsselwörter

Suchterkrankungen - Persönlichkeitsstörungen - Komorbidität - Behandlung

Key words

substance use disorder - personality disorder - comorbidity - treatment

Publikationsverlauf

Artikel online veröffentlicht:
26. September 2022

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