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Aggressivität, emotionale Instabilität und Impulsivität bei der Borderline-Persönlichkeitsstörung

Aggressiveness, emotional instability and impulsiveness in borderline personality disorder

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Forensische Psychiatrie, Psychologie, Kriminologie Aims and scope Submit manuscript

Zusammenfassung

Aggressives Verhalten ist ein häufig zu beobachtendes Phänomen bei Männern und Frauen mit einer Borderline-Persönlichkeitsstörung (BPS). Auch unter Gefängnisinsassen, die wegen Gewaltdelikten einsitzen, ist von einem bedeutsamen Anteil an Menschen auszugehen, die die Kriterien einer BPS erfüllen. Die Aggressivität von BPS-Patienten ist überwiegend, wenn auch nicht ausschließlich, reaktiv und steht in engem Zusammenhang mit der emotionalen Dysregulation als zentrales psychopathologisches Merkmal der BPS. Im Sinne einer sequenziellen Mediation wird der Zusammenhang zwischen BPS und aggressivem Verhalten über die emotionale Dysregulation und die Neigung zu häufigen und heftigen Ärgergefühlen vermittelt. Typische Trigger-Situationen sind soziale Zurückweisungssituationen, die an die Neigung von BPS-Patienten zu sozialem Bedrohungserleben im Zusammenhang mit niedrigem bzw. labilem Selbstwert anknüpfen. Auf der Ebene zugrunde liegender neurobiologischer Mechanismen sind funktionelle Störungen präfrontolimbischer zerebraler Netzwerke anzunehmen, die unter dem Einfluss von Serotonin, (Anti)Stress- und Geschlechtshormonen stehen. Unser heutiges Wissen über die Aggressivität von Menschen mit BPS lässt es realistisch erscheinen, zukünftig spezifischere psychotherapeutische und vielleicht auch pharmakologische Behandlungsmöglichkeiten zum Abbau reaktiv-aggressiven Verhaltens für diese Patientengruppe zur Verfügung zu haben.

Abstract

Aggressive behavior is frequently observed in men and women diagnosed with borderline personality disorder (BPD). It can be assumed that BPD is also frequent among prisoners sentenced for violent crimes, who fulfil the criteria for BPD. The aggressiveness of BPD patients is predominantly, but not exclusively reactive and is closely linked to emotional dysregulation as a central psychopathological feature of BPD. The association between BPD and aggressive behavior is mediated via the emotional dysregulation and the tendency to frequent and fierce feelings of anger in the sense of sequential mediation. Interpersonal rejection situations typically serve as triggers, which link with the tendency of BPD patients to experience social threat in the context of a low and labile self-confidence. At the level of the underlying neurobiological mechanisms, functional disorders of the prefrontal-limbic cerebral network are assumed, which are under the control of serotonin, (anti)stress and sex hormones. Based on the current knowledge on aggression in individuals with BPD it seems realistic to assume that specific psychotherapeutic and perhaps even pharmacological treatment approaches will become available in the future to reduce the reactive aggressive behavior in this patient group.

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  1. Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie der Universität Heidelberg, Voßstr. 2, 69115, Heidelberg, Deutschland

    Sabine C. Herpertz, Falk Mancke & Katja Bertsch

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  1. Sabine C. Herpertz
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Correspondence to Sabine C. Herpertz.

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Das Manuskript nimmt Anleihen bei Mancke F, Herpertz SC, Bertsch K. Aggression in borderline personality disorder: a multidimensional model. J Personal Disord (2015) 6(3):278–291 (2015).

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Herpertz, S.C., Mancke, F. & Bertsch, K. Aggressivität, emotionale Instabilität und Impulsivität bei der Borderline-Persönlichkeitsstörung. Forens Psychiatr Psychol Kriminol 10, 189–197 (2016). https://doi.org/10.1007/s11757-016-0379-y

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