Fiedler (1994) zitiert zwei ältere Katamnese-Studien (Tölle 1966 und Müller 1981; Nachuntersuchungen nach 28 bzw. 30 Jahren), die unabhängig zu ähnlichen Ergebnissen geführt haben:
- Die Störungsspezifität blieb im Zeitverlauf weitgehend stabil
- Es fand sich eine Besserung im Alter im Sinne einer Anpassung auf niedrigem Niveau
- Es treten kaum noch neue Symptome in der 2. Lebenshälfte auf
- Die Verlaufseigenarten sind sehr unterschiedlich
- häufig sind Suizide
- Spitzen dysfunktionalen Verhaltens finden sich v.a. im Umfeld von Extrembelastungen oder Lebenskrisen
Laut Fiedler (1994, S. 387) deuten Prospektiv-Studien darauf hin,
„daß die persönlichkeitsgestörten Patienten im Vergleich mit Patienten ohne Persönlichkeitsstörungen
- erheblich größere Anpassungsschwierigkeiten in Familie und Beruf aufweisen,
- sich deutlich häufiger erneut einer psychotherapeutischen oder psychiatrischen Behandlung unterzogen,
- häufigere Ehescheidungen oder längere Zeiten ohne feste Partnerschaft aufwiesen sowie
- deutlich häufiger wegen unterschiedlicher körperlicher Krankheiten ärztliche Hilfe in Anspruch genommen hatten (Drake, Adler & Vaillant, 1988; Andreoli, Gressot, Aapro, Trico & Cognalons, 1989).“
Nach Tölle (1986) gibt es eine Drittelregel, „wenn psychologische, medizinische und soziale Daten zusammengefaßt werden“:
- 1/3 ungünstiger Krankheits-Verlauf mit rezid. Krisen, Konflikten und Versagen (33,9%)
- 1/3 Soziales Nischendasein unter Akzeptanz weitgehender Kompromisse (34,8%): Es gingen „ausreichende Adaptation und relatives Wohlbefinden mit Vitalitätseinbuße und Antriebsverminderung einher, was im Sinne eines Abwehrvorganges zu interpretieren ist, der vor Überbeanspruchung und Konflikten schützt. Diese Residualzustände entsprechen phänomenologisch und psychodynamisch denen von Neurosepatienten“
- 1/3 günstiger Verlauf mit z.T. guter Lebensbewältigung (31,3%)
Evaluationsstudien
Es existieren nur für zwei der Persönlichkeitsstörungen Studien über Langzeitverläufe, das sind
- die Borderline-Persönlichkeitsstörung und
- die antisoziale Persönlichkeitsstörung
Langzeitkatamnesen von mit Psychotherapie und/oder Pharmakotherapie behandelten Patienten mit Persönlichkeitsstörungen sind nicht vorhanden.
Die Menninger Studie
Bei der sogenannten „Menninger Studie“ handelt es sich um eine 1954 begonnene Studie, bei der 42 ambulant und stationnär psychotherapeutisch behandelte Patienten 1972 und 1986 nachuntersucht wurden (Kernberg et al., 1972; Wallerstein, 1986). Die Diagnosen umfaßten schwere Psychoneurosen, Charakterneurosen, Impulsneurosen, Suchterkrankungen, Sexualstörungen, narzisstische und Borderline-Störungen. Sie wurden zunächst in der Menninger Klinik diagnostiziert und anschließend ambulant weiterbehandelt.
Therapeutisch wurden
- 21 Patienten psychoanalytisch und
- 21 Patienten mittels expressiver oder supportiver Psychotherapie behandelt.
Die Therapiedauer betrug zwischen 3 und 9 Jahren und beinhaltete im Mittel
- 835 Stunden Psychoanalyse und
- 289 Stunden Psychotherapie
Die Katamnesen wurden 12 Jahre und 30 Jahre nach Beginn der Therapie durchgeführt.
Bronisch (2000) fasst die Ergebnisse wie folgt zusammen:
- In keiner der Behandlungen, auch der psychoanalytischen Behandlungen, wurde ausschließlich klassisch analytisch behandelt.
- Am Ende der Therapie wurden lediglich 8 von den 21 analytisch behandelten Patienten annähernd klassisch analytisch behandelt
- „Expressive“ und „supportive“ Therapie vermischten sich bei den anderen 21 Fällen, die psychotherapeutisch behandelt wurden.
- Psychoanalytische „Einsicht“ in die zugrundeliegenden Konflikte wurde bei 7 von 21 psychoanalytisch behandelten und bei 12 von 21 psychotherapeutisch behandelten Patienten erreicht.
- Psychotherapie erbrachte einen besseren Erfolg als Psychoanalyse.
Der Therapieerfolg konnte zu Beginn der Behandlung nicht vorausgesagt werden.
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