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

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