Komorbiditäten bei Patienten mit einer Narzisstischen Persönlichkeitsstörung im Vergleich zu Patienten mit einer Borderline-Persönlichkeitsstörung

Zusammenfassung

Hintergrund: Patienten mit einer Narzisstischen Persönlichkeitsstörung (NPS) begeben sich häufig nicht aufgrund ihrer NPS in psychiatrische oder psychotherapeutische Behandlung, sondern eher aufgrund komorbider Störungen oder einer erhöhten psychischen Belastung. Bisher gibt es keine aktuellen Daten zu den Komorbiditätsraten und zur allgemeinen psychischen Belastung dieser Patienten.

Fragestellung: Welche aktuellen komorbiden Achse-I- bzw. Achse-II-Störungen treten bei NPS-Patienten im Vergleich zu Patienten mit einer Borderline Persönlichkeitsstörung (BPS) im klinischen Setting auf? Wie sieht die psychische Belastung der NPS-Patienten aus?

Methodik: Die Punkt- und Lebenszeit-Prävalenzen der komorbiden Störungen (Strukturiertes Klinisches Interview für DSM-IV Achse I und II) und die allgemeine Symptombelastung (SCL-90-R) und Depressivität (BDI) wurden bei 62 NPS-Patienten, 62 BPS-Patienten und 59 Patienten mit der Doppeldiagnose NPS/BPS erhoben.

Ergebnisse: Die häufigsten Störungsbilder bei den NPS-Patienten waren affektive Störungen (64,5%) und Störungen durch Substanzkonsum (35,5%). Im Vergleich traten Störungen durch Substanzkonsum (p<0,01) und PTBS (p<0,01) häufiger bei der BPS als bei der NPS auf. Die Major Depression (p<0,05) trat häufiger bei NPS-Patienten auf als bei Patienten mit beiden Diagnosen und die beiden Diagnosen Störungen durch Substanzkonsum (p<0,001) und Antisoziale PS (p<0,001) wurden häufiger bei NPS/BPS-Patienten diagnostiziert als bei NPS-Patienten. Geschlechtseffekte ließen sich für die PTBS, Bulimia nervosa, Störungen durch Substanzkonsum und Antisoziale PS finden. Die NPS ging mit einer geringen Anzahl an zusätzlichen Diagnosen auf den Achsen I und II und mit geringeren Werten in der allgemeinen Symptombelastung und Depressivität im Vergleich mit BPS-Patienten einher.

Schlussfolgerungen: Allgemein zeigen NPS-Patienten ähnliche Komorbiditäten wie Patienten mit einer BPS oder einer NPS/BPS, weisen aber eine deutlich geringere psychische Belastung und Depressivität auf.

Abstract

Background: Patients with a narcissistic personality disorder (NPD) do not often consult a psychotherapist or psychiatrist because of their NPD, but rather, because of co-occurring psychiatric disorders, or higher general symptom stress. Until now there is no actual data about rates of co-occurrence disorders and general symptom stress.

Objective: Which axis I and axis II disorders occur typically in NPD in comparison to patients with a borderline personality disorder (BPD)? How are general symptom stress and depressive symptoms related?

Methods: Prevalence of co-occurring disorders (Structured Clinical Interview for DSM-IV for Axis I and Axis II) and general symptom stress (SCL-90-R) and depression (BDI) were investigated in 62 patients with a NPD, 62 patients with a BPD and 59 patients with a double diagnosis NPD/BPD.

Results: Affective disorders (64.5%) and substance use disorders (35.5%) were the most comorbid psychiatric disorders in patients with NPD. Substance use disorders (p<0.01) and posttraumatic stress disorder (PTSD) (p<0.01) were more common in BPD than in NPD. In comparison to patients with the double diagnosis NPD/BPD major depression (p<0.05) was more frequent in patients with NPD and substance use disorders (p<0.001) and antisocial personality disorder (p<0.001) were less common in patients with NPD. Gender effects were found in PTSD, bulimia nervosa, substance use disorders and antisocial personality disorder. Patients with NPD showed lowest rates of co-occurring disorders and lowest scores in general symptom stress and depression than the other two groups.

Conclusions: In general, patients with NPD showed similar co-occurring disorders as patients with BPD, or with the co-diagnosis NPD and BPD, but they showed lower scores for general symptom stress and depression.

Key words

comorbidity - narcissistic personality disorder - borderline personality disorder

Literatur

• 1 American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington, DC: American Psychiatric Press 1994
• 2 Morey LC. Personality Disorders in DSM-III and DSM-III-R: Convergence, coverage, and internal consistency.  Am J Psychiatry. 145;  573–577 1988
• 3 Westen D, Shedler J, Bradley R. A prototype approach to personality disorder diagnosis.  Am J Psychiatry. 2006;  163 846-856
• 4 American Psychiatric Association . Diagnostic and statistical manual of mental disorders (3rd ed.) Washington, DC: American Psychiatric Press 1980
• 5 Dilling H, Mombour W, Schmidt MH. Hrsg. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F). Klinisch-diagnostische Leitlinien. Bern: Huber 2000
• 6 Lenzenweger MF, Loranger AW, Korfine L. et al . Detecting personality disorders in a nonclinical population. Application of a 2-stage procedure for case identification.  Arch Gen Psychiatry. 1997;  54 345-351
• 7 Torgersen S, Kringlen E, Cramer V. The prevalence of personality disorders in a community sample.  Arch Gen Psychiatry. 2001;  58 590-596
• 8 Samuels J, Eaton WW, Bienvenu 3rd OJ. et al . Prevalence and correlates of personality disorders in a community sample.  Br J Psychiatry. 2002;  180 536-542
• 9 Crawford TN, Cohen P, Johnson JG. et al . Self-reported personality disorder in the children in the community sample: Convergent and prospective validity in late adolescence and adulthood.  J Personal Disord. 2005;  19 30-52
• 10 Coid J, Yan M, Tyrer P. et al . Prevalence and correlates of personality disorder in Great Britain.  Br J Psychiatry. 2006;  188 423-431
• 11 Stinson FS, Dawson DA, Goldstein RB. et al . Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.  J Clin Psychiatry. 2008;  69 1033-1045
• 12 Skodol AE, Oldham JM, Gallaher PE. Axis II comorbidity of substance use disorders among patients referred for treatment of personality disorders.  Am J Psychiatry. 1999;  156 733-738
• 13 Verheul R. Co-morbidity of personality disorders in individuals with substance use disorders.  Eur Psychiatry. 2001;  16 274-282
• 14 James LM, Taylor J. Impulsivity and negative emotionality associated with substance use problems and Cluster B personality in college students.  Addict Behav. 2007;  32 714-727
• 15 Kokkevi A, Stefanis N, Anastasopoulou E. et al . Personality disorders in drug abusers: prevalence and their association with AXIS I disorders as predictors of treatment retention.  Addict Behav. 1998;  23 841-853
• 16 Skinstad AH, Swain A. Comorbidity in a clinical sample of substance abusers.  Am J Drug Alcohol Abuse. 2001;  27 45-64
• 17 Taylor J. Substance use disorders and Cluster B personality disorders: physiological, cognitive, and environmental correlates in a college sample.  Am J Drug Alcohol Abuse. 2005;  31 515-535
• 18 DeJong CA, van den BW, Harteveld FM. et al . Personality disorders in alcoholics and drug addicts.  Compr Psychiatry. 1993;  34 87-94
• 19 Morgenstern J, Langenbucher J, Labouvie E. et al . The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence rates and relation to alcohol typology variables.  J Abnorm Psychology. 1997;  106 74-84
• 20 Landheim AS, Bakken K, Vaglum P. Gender differences in the prevalence of symptom disorders and personality disorders among poly-substance abusers and pure alcoholics.  Eur Addict Res. 2003;  9 8-17
• 21 Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients.  Am J Psychiatry. 2005;  162 1911-1918
• 22 Verheul R, Kranzler HR, Poling J. et al . Co-occurrence of Axis I and Axis II disorders in substance abusers.  Acta Psychiatr Scand. 2000;  101 110-118
• 23 Newton-Howes G, Tyrer P, North B. et al . The prevalence of personality disorder in schizophrenia and psychotic disorders: systematic review of rates and explanatory modeling.  Psychological Medicine. 2007;  1-8
• 24 Hogg B, Jackson HJ, Rudd RP. et al . Diagnosing personality disorders in recent-onset schizophrenia.  J Nerv Ment Dis. 1990;  178 194-199
• 25 Kool S, Dekker J, Duijsens IJ. et al . Major depression, double depression and personality disorders.  J Personal Disord. 2000;  14 274-281
• 26 Alnaes R, Torgersen S. DSM-III personality disorders among patients with major depression, anxiety disorders, and mixed conditions.  J Nerv Ment Dis. 1990;  178 693-698
• 27 Bellino S, Patria L, Paradiso E. et al . Major depression in patients with borderline personality disorder: a clinical investigation.  Can J Psychiatry. 2005;  50 234-238
• 28 Garno JL, Goldberg JF, Ramirez PM. et al . Bipolar disorder with comorbid cluster B personality disorder features: impact on suicidality.  J Clin Psychiatry. 2005;  66 339-345
• 29 Schiavone P, Dorz S, Conforti D. et al . Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study.  Psychol Rep. 2004;  95 121-128
• 30 Brieger P, Ehrt U, Marneros A. Frequency of comorbid personality disorders in bipolar and unipolar affective disorders.  Compr Psychiatry. 2003;  44 28-34
• 31 Vieta E, Colom F, Martinez-Aran A. et al . Bipolar II Disorder and comorbidity.  Compr Psychiatry. 2000;  41 339-343
• 32 Pica S, Edwards J, Jackson HJ. et al . Personality disorders in recent-onset bipolar disorder.  Compr Psychiatry. 1990;  31 499-510
• 33 Dyck IR, Phillips KA, Warshaw MG. et al . Patterns of personality pathology in patients with generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia.  J Personal Disord. 2001;  15 60-71
• 34 Mavissakalian MR, Hamann MS, Haidar SA. et al . DSM-III personality disorders in generalized anxiety, panic/agoraphobia, and obsessive-compulsive disorders.  Compr Psychiatry. 1993;  34 243-248
• 35 Hummelen B, Wilberg T, Pedersen G. et al . The relationship between avoidant personality disorder and social phobia.  Compr Psychiatry. 2007;  48 348-356
• 36 Gasperini M, Battaglia M, Diaferia G. et al . Personality features related to generalized anxiety disorder.  Compr Psychiatry. 1990;  31 363-368
• 37 Joffe RT, Swinson RP, Regan JJ. Personality features in obsessive compulsive disorder.  Am J Psychiatry. 1988;  145 1127-1129
• 38 Stanley MA, Turner SM, Borden JW. Schizotypal Features in Obsessive-Compulsive Disorder.  Compr Psychiatry. 1990;  31 511-518
• 39 Yates WR, Sieleni B, Reich J. et al . Comorbidity of bulimia nervosa and personality disorder.  J Clin Psychiatry. 1989;  50 57-59
• 40 Gartner AF, Marcus RN, Halmi K. et al . DSM-III-R personality dis-orders in patients with eating disorders.  A J Psychiatry. 1989;  146 1585-1591
• 41 Jordan J, Joyce PR, Carter FA. et al . Specific and nonspecific Comorbidity in anorexia nervosa.  Int J Eat Disord. 2008;  41 47-56
• 42 Alnaes R, Torgersen S. The relationship between DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population.  Acta Psychiatr Scand. 1988;  78 485-492
• 43 Zanarini MC, Gunderson JG, Frankenburg FR. Axis I phenomenology of borderline personality disorder.  Compr Psychiatry. 1989;  30 149-156
• 44 Zimmerman M, Mattia JI. Axis I diagnostic comorbidity and borderline personality disorder.  Compr Psychiatry. 1999;  40 245-252
• 45 Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.  Am J Psychiatry. 1999;  156 1563-1569
• 46 Links PS, Steiner M, Offord DR. et al . Characteristics of borderline personality disorder: a Canadian study.  Can J Psychiatry. 1988;  33 336-340
• 47 Shearer SL. Dissociative phenomena in women with borderline personality disorder.  Am J Psychiatry. 1994;  151 1324-1328
• 48 Zanarini MC, Frankenburg FR, Dubo ED. et al . Axis I comorbidity of borderline personality disorder.  Am J Psychiatry. 1998;  155 1733-1739
• 49 Johnson DM, Shea MT, Yen S. et al . Gender differences in borderline personality disorder: findings from the Collaborative Longitudinal Personality Disorders Study.  Compr Psychiatry. 2003;  44 284-292
• 50 Gunderson J, Ronningstam E, Smith L. Narcissistic personality disorder: A review of data on DSM-III-R descriptions.  J Pers Disord. 1991;  5 167-177
• 51 McGlashan TH, Grilo CM, Skodol AE. et al . The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.  Acta Psychiatr Scand. 2000;  102 256-264
• 52 Zanarini MC, Frankenburg FR, Vujancovic AA. et al . Axis II comorbidity of borderlien personality disorder: description of 6-year course and prediction to time-to-remission.  Acta Psychiatr Scand. 2004;  110 416-420
• 53 Nurnberg HG, Raskin M, Levine PE. et al . The comorbidity of borderline personality disorder and other DSM-III-R axis II personality disorders.  Am J Psychiatry. 1991;  148 1371-1377
• 54 Lieb K, Zanarini MC, Schmahl C. et al . Borderline personality disorder.  Lancet. 2004;  364 453-461
• 55 Tschanz BT, Morf CC, Turner CW. Gender differences in the structure of narcissism: A multi-sample analysis of the narcissistic personality inventory.  Sex Roles. 1998;  38 863-870
• 56 Golomb M, Fava M, Abraham M. et al . Gender differences in personality disorders.  Am J Psychiatry. 1995;  152 579-582
• 57 Grilo CM, Becker DF, Walker ML. et al . Gender differences in personality disorders in psychiatrically hospitalized young adults.  J Nerv Ment Dis. 1996;  184 754-757
• 58 Lenzenweger MF, Lane MC, Loranger AW. et al . DSM-IV personality disorders in the National Comorbidity Survey Replication.  Biol Psychiatry. 2007;  62 553-564
• 59 Torgersen S, Lygren S, Oien PA. et al . A twin study of personality disorders.  Compr Psychiatry. 2000;  41 416-425
• 60 Zimmerman M, Coryell WH. DSM-III personality disorder dimensions.  J Nerv Ment Dis. 1990;  178 686-692
• 61 Corbitt EM, Widiger TA. Sex differences among the personality disorders: An exploration of the data.  Clin Psychology: Science and Practice. 1995;  2 225-238
• 62 Zanarini MC, Frankenburg FR, Dubo ED. et al . Axis II comorbidity of borderline personality disorder.  Compr Psychiatry. 1998;  39 296-302
• 63 Merkl A, Roepke S, Dams A. et al . Gender differences in male and female patients with borderline personality disorder.  Unveröffentlichte Daten.
• 64 First MB, Spitzer RL, Gibbon M. et al . Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Version 2.0 New York: Biometrics Research Department, New York State Psychiatric Institute 1996
• 65 Fydrich T, Renneberg B, Schmitz B. et al . Strukturiertes Klinisches Interview für DSM-IV, Achse II: Persönlichkeitsstörungen. Göttingen: Hogrefe 1997
• 66 First MB, Gibbon M, Spitzer RL. et al . Structured Clinical Interview for DSM-IV Axis I Disorders – Clinician Version (SCID-CV). Washington, DC: American Psychiatric Association 1997
• 67 Wittchen HU, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview für DSM-IV, Achse I: Psychische Störungen. Göttingen: Hogrefe 1997
• 68 Sheehan DV, Lecrubier Y, Harnett-Sheehan K. et al . The mini international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview.  J Clin Psychiatry. 1998;  59 22-33
• 69 Ackenheil M, Stotz G, Dietz-Bauer R. et al . Mini International Interview – German Version 5.0.0 München, Psychiatrische Universitätsklinik München 1999
• 70 Derogatis LR. SCL-90-R, administration, scoring and procedures manual-I for the Revised version. Baltimore: John Hopkins University School of Medicine 1977
• 71 Franke GH. Symptom-Checkliste von L.R. Derogatis – Deutsche Version (SCL-90-R). Göttingen: Beltz 1995
• 72 Beck AT, Ward CH, Mendelson M. et al . An inventory for measuring depression.  Arch Gen Psychiatry. 1961;  4 561-571
• 73 Hautzinger M, Bailer M, Worall H. et al . Beck-Depressions-Inventar (BDI). Testhandbuch. (2. überarbeitete Auflage). Bern: Hans Huber 1995
• 74 Lehrl S. Mehrfach-Wortschatz-Intelligenztest (MWT-B). Balingen: Spitta Verlag 2005
• 75 Horn W. L-P-S Leistungsprüfsystem. Göttingen: Hogrefe 1983
• 76 Cohen P, Chen H, Crawford TN. et al . Personality disorders in early adolescence and the development of later substance use disorders in the general population.  Drug Alcohol Depend. 2007;  88 ((1)) 71-84
• 77 Luhtanen RK, Crocker J. Alcohol use in college students: effects of level of self-esteem, narcissism, and contingencies of self-worth.  Psychol Addict Behav. 2005;  19 99-103
• 78 Corbisiero JR, Reznikoff M. The relationship between personality type and style of alcohol use.  J Clin Psychol. 1991;  47 291-298
• 79 Alnaes R, Torgersen S. Personality and personality disorders among patients with various affective disorders.  J Pers Disord. 1991;  5 107-121
• 80 Rose P. The happy and unhappy faces of narcissism.  Pers Indiv Dif. 2002;  33 379-391
• 81 Campbell WK, Rudich EA, Sedikides C. Narcissism, self-esteem, and the positivity of self-views: Two portraits of self-love.  Pers Soc Psychol Bull. 2002;  28 358-368
• 82 Rhodewalt F, Morf CC. Self and interpersonal correlates of the narcissistic personality inventory.  J Res Pers. 1995;  29 1-23
• 83 Rhodewalt F, Morf CC. On self-aggrandizement and anger: A temporal analysis of narcissism and affective reactions to success and failure.  J Pers Soc Psychol. 1998;  74 672-685
• 84 Watson PJ, Biderman MD. Narcissistic Personality Inventory factors, splitting and self-consciousness.  J Pers Assess. 1993;  61 41-57
• 85 Wink P. Two faces of narcissism.  J Pers Soc Psych. 1991;  61 590-597
• 86 Mitchell PB, Parker GB, Gladstone GL. et al . Severity of stressful life events in first and subsequent episodes of depression: The relevance of depressive subtype.  J Affect Disor. 2003;  73 245-252
• 87 Brown GW, Harris TO, Hepworth C. Life events and endogenous depression. A puzzle reexamined.  Arch Gen Psychiatry. 1994;  51 525-534
• 88 Henseler H. Narzisstische Krisen. Zur Psychodynamik des Selbstmordes. Wiesbaden: Westdeutscher Verlag 2000
• 89 Beck AT, Freemann A. Kognitive Therapie der Persönlichkeitsstörungen. Weinheim: Beltz 1999
• 90 Barnett PA, Gotlib IH. Psychosocial functioning and depression: distinguishing among antecedents, concomitants, and consequences.  Psychol Bull. 1988;  104 97-126
• 91 Clark LA, Livesley WJ, Schroeder ML. et al . Convergence of two systems for assessing personality disorder.  Psychol Assess. 1996;  8 294-303
• 92 Miller JD, Lynam DR, Widiger TA. et al . Personality disorders as extreme variants of common personality dimensions: can the five-factor model adequately represent psychopathy?.  J Pers. 2002;  69 253-276
• 93 Trull TJ. DSM-III-R personality disorders and the five-factor model of personality: an empirical comparison.  J Abnorm Psychol. 1992;  101 553-560
• 94 Kupfer DJ, First MB, Regier DA. A research agenda for DSM-V. Washington DC: American Psychiatric Association 2002
• 95 Cramer V, Torgersen S, Kringlen E. Personality disorders and quality of life. A population study.  Compr Psychiatry. 2006;  47 178-184
• 96 Lynch TR, Cheavens JS. Dialectical behavior therapy for comorbid personality disorders.  J Clin Psychol. 2008;  64 154-167
• 97 Heuser I, Lammers CH. Stress and the brain.  Neurobiol Aging. 2003;  24 69-76
• 98 Zlotnick C, Rothschild L, Zimmerman M. The role of gender in the clinical presentation of patients with borderline personality disorder.  J Personal Disord. 2002;  16 277-282
• 99 Dawe S, Loxton NJ. The role of impulsivity in the development of substance use and eating disorders.  Neurosci Biobehav Rev. 2004;  28 343-351
• 100 Grube M. Gender differences in aggressive behavior at admission to a psychiatric hospital.  Aggress Behav. 2007;  33 97-103
• 101 Jacobi C, Paul T, Thiel A. Fortschritte der Psychotherapie. Band 24: Ess-Störungen. Göttingen: Hogrefe 2004
• 102 Brady KT, Randall CL. Gender difference in substance use disorders.  Addic Disord. 1999;  22 241-252
• 103 Conway KP, Compton W, Stinson FS. et al . Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  J Clin Psychiatry. 2006;  67 247-257
• 104 Linzer M, Spitzer R, Kroenke K. et al . Gender, quality of life, and mental disorders in primary care: results from the PRIME-MD 1000 study.  Am J Med. 1996;  101 526-533
• 105 Ladwig KH, Marten-Mittag B, Formanek B. et al . Gender differences of symptom reporting and medical health care utilization in the German population.  Eur J Epidemiol. 2000;  16 511-518
• 106 Wilhelm K, Parker G, Geerligs L. et al . Women and depression: a 30 year learning curve.  Aust N Z J Psychiatry. 2008;  42 3-12
• 107 Grigoriadis S, Robinson GE. Gender issues in depression.  Ann Clin Psychiatry. 2007;  19 247-255
• 108 Blais MA, Kelley JM, Holdwick Jr DJ. et al . The perceived clarity and understandability of the DSM-IV personality disorder criteria sets.  Compr Psychiatry. 2001;  42 466-470
• 109 Widiger TA, Frances A, Spitzer RL. et al . The DSM-III-R personality disorders: an overview.  Am J Psychiatry. 1988;  145 786-795
• 110 Zimmerman M. Diagnosing personality disorders.  A review of issues and research methods. Arch Gen Psychiatry. 1994;  51 225-245
• 111 Livesley WL. Conceptual and taxonomic issues. In: Livesley WL (Ed.) Handbook of personality disorders: Theory, research, and treatment. New York: Guilford 2001: 3-38
• 112 Pinninti NR, Madison H, Musser E. et al . MINI International Neuropsychiatric Schedule: clinical utility and patient acceptance.  European Psychiatry. 2003;  18 361-364

Korrespondenzadresse