[Trauma-related disorders in patients with borderline personality disorders. Results of a multicenter study]. / Traumafolgestörungen bei Patienten mit Borderline-Persönlichkeitsstörung : Ergebnisse einer Multicenterstudie.

BACKGROUND: There is current controversy about the diagnostic overlap between personality disorders and trauma-related disorders. PATIENTS AND METHODS: Applying a multicenter study design, trauma-related disorders were investigated via interview assessment in 136 patients with borderline personality disorder (BPD) in 5 specialized treatment centers. Additionally a spectrum of psychological symptoms and prevalence of lifetime traumatic experiences were assessed by questionnaire measures. RESULTS: Diagnostic overlap between BPD and PTSD was found to be high (79%) as well as the overlap of BPD with complex PTSD (55%) and severe dissociative disorders (41%). Including neglect and emotional violence as trauma categories, an extremely high prevalence of lifetime traumatic experiences was reported (96%). Experiences of sexual violence were reported by 48% of all female and 28% of all male patients. Severe forms of physical violence were reported by 65% of all patients. CONCLUSIONS: BPD patients with severe psychopathology show a high comorbidity with trauma-related disorders including dissociative disorders. This association has to be taken into account when planning psychological treatment.

Amygdala and hippocampal volumes and cognition in adult survivors of childhood abuse with dissociative disorders.

OBJECTIVE: Trauma-exposed individuals with post-traumatic stress disorder (PTSD) display reduced amygdala and hippocampal size and impaired cognition. However, studies on trauma-exposed individuals with dissociative amnesia (DA) or dissociative identity disorder (DID) are lacking. METHOD: Twenty-three young women who had experienced severe childhood sexual/physical abuse, diagnosed with DA/DID or PTSD, and 25 healthy control subjects were subjected to 3D structural magnetic resonance imaging of amygdala and hippocampus and a clinical and neuropsychological investigation. RESULTS: Compared with controls, trauma-exposed subjects with PTSD (n = 10) displayed significantly reduced amygdala and hippocampal size and significantly impaired cognition. By contrast, trauma-exposed subjects with DA or DID (n = 13) displayed normal amygdala and hippocampal size and normal cognition. CONCLUSION: We report for the first time volumetric results in subjects with DA/DID without PTSD as comorbid diagnosis. Our results indicate preserved amygdala and hippocampal size and preserved cognition in subjects with these disorders.

[Step by step: differential indication and specialized in-door psychotherapy as implemented in a psychiatric-psychotherapeutic state hospital]. / Schritt für Schritt: Differenzialindikation und spezialisierte stationäre Psychotherapie in einer psychiatrisch-psychotherapeutischen Fachklinik der Regionalversorgung.

Different patients need different treatment, when in-door psychotherapy is the indication. Also, in the course of psychotherapeutic treatment a change of setting might be useful or necessary. It is shown how this knowledge can be put into work in a psychiatric-psychotherapeutic state hospital with obligatory service, using an integrated group of several specialized wards.

[Symptom complex, prevalence of trauma and body image of psychiatric patients with self-injury behavior]. / Symptomkomplex, Traumaprävalenz und Körperbild von psychisch Kranken mit selbstverletzendem Verhalten (SVV).

Within the group of in-patients the patients exhibiting self-injurious behavior (SIB) have a significantly more disturbed body image--as assessed by the Holtzman Inkblot Technique (HIT)--than the patients who do not have this symptomatology. The more disturbed the body image, the higher the frequency of SIB. The method of self-injury most frequently reported is cutting the skin of the extremities, followed by burning the skin with cigarettes or open flames. This behavior serves the purpose of alleviating diffuse internal tension, of directing aggression inward, i.e. toward the self, and of terminating depersonalization states. During the act of self-mutilation, the perception of pain is lessened appreciably or inactivated. 48 percent of the female patients in this group suffered sexual abuse during childhood.