Kategoriale versus dimensionale Klassifikation von Persönlichkeitsstörungen: sind dimensionale Modelle die Zukunft?

Zusammenfassung

Die kategoriale Klassifikation von Persönlichkeitsstörungen (PS) im ICD-10 bzw. DSM-IV weist eine Vielzahl von Problemen auf, unter anderem wird die hohe Komorbidität von PS mit Achse-I- bzw. anderen Achse-II-Störungen unzureichend berücksichtigt und die jeweilige Anzahl zu erfüllender Kriterien erscheint beliebig. Aus diesem Grund plädieren eine Vielzahl von Autoren für eine dimensionale Klassifikation von PS. Allerdings existieren nur wenige Studien zur Anwendbarkeit solcher Modelle für PS, wobei die meisten Befunde zum Big Five vorliegen. In dieser Arbeit werden Befunde zur Anwendbarkeit des biopsychosozialen „Sieben-Faktoren-Modells” von Cloninger zur Klassifikation von PS vorgestellt. Die Ergebnisse belegen grundsätzlich, dass das Sieben-Faktoren-Modell gut zwischen Personen mit PS, Individuen mit Achse-I-Störungen und psychisch Gesunden differenzieren kann. Die Ergebnisse werden diskutiert und ein modifiziertes Diagnoseschema zur Klassifikation von PS vorgestellt.

Abstract

The classification of personality disorders (PD) according to ICD-10 and DSM-IV has been critisized for several reasons. For example, those who have attempted to validate the presence of a non-arbitrary distinction between normal and abnormal personality functioning have suggested that no such distinction exists. Furthermore, PDs frequently co-occur with a number of Axis-I conditions and other Axis-II disorders leading to multiple diagnoses. Therefore, many have suggested classifying PDs dimensionally, rather than categorically. However, there are only a few studies that have investigated the applicability of these models with respect to PDs, and most of these studies used the Big Five. In this study we investigated the applicability of the Seven-Factor model of temperament and character for the classification of PDs. Our results show that the Seven-Factor model discriminates well between PDs and healthy controls, as well as between PDs and Axis-I disorders. We discuss our findings and present a modified scheme to diagnose PDs.

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