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Yıl:2005; Cilt: 15; Sayı: 2>> Özet
TAM METİN
Klinik Psikofarmakoloji Bülteni; 2005;15(2):65-70
Sınır kişilik bozukluğu hastalarında vücut dismorfik bozukluğu, travma ve disosiyasyon: Bir önçalışma
ÜB Semiz, C Başoğlu, S Ebrinç, BM Ergün, CO Noyan, M Çetin
GATA Haydarpasa Eğt. Hast. Psikiyatri Servisi İstanbul
Amaç: Çalışmanın amacı, sınır kişilik bozukluğu (SKB) hastalarında vücut dismorfik bozukluğu (VDB) sıklığının araştırılması ve çocukluk çağı travmatik yaşantıları ve disosiyasyon ile ilişkisisin saptanmasıdır.
Yöntem: Çalışmaya yaşları 18-42 arasında değişen DSM-IV ölçütlerine göre SKB tanısı almış ardışık 35 hasta ile cinsiyet ve yaş eşleştirilmiş 35 sağlıklı kontrol dahil edilmiştir. Denekler SCID-I, SCID-II, VDB için geliştirilmiş SCID benzeri yarıyapılandırılmış görüşme formu, Disosiyatif Yaşantılar Ölçeği (DES), Somatoform Disosiyasyon Anketi (SDQ), Travmatik Yaşantılar Ölçeği (TEC) ve Hamilton Depresyon Derecelendirme Ölçeğinden (HAM-D) oluşan kapsamlı bir tanısal batarya ile değerlendirilmiştir.
Bulgular: Çalışma gurubunda SKB için karşılanan ortalama DSM-IV ölçütü sayısı 7.7 (SS = 1.4) idi ve %28.5’i çocukluk çağı Şziksel tacizi, %28.5’i çocukluk çağı cinsel tacizi, %8.5’i duygusal taciz, %60’ı ihmal ve %14’ü birden fazla travma bildirmekteydi. SKB grubunda kontrol grubuna kıyasla DES (t=26.38; p<0.001), SDQ (t=20.65; p<0.001) ve TEC (t=4.98; p<0.05) puanları anlamlı derecede yüksekti. Ömür boyu VDB prevalansı %80 olarak bulundu. SKB grubunda VDB tanısı ile çocukluk çağı travma öyküsü (r=0.099; p>0.05) ve disosiyasyon puanları (DES r=0.059, p>0.05; DISQ r=0.005, p>0.05) arasındaki bağıntı anlamlı değildi.
Sonuç: SKB ve VDB’nin birlikte bulunduğu bireylerdeki patolojinin doğası ve derecesi hakkındaki bilgimiz sınırlıdır. VDB ve SKB’nin bazı özelliklerinin ilişkili olabileceği akla yatkın bir önermedir. Bizim örneklemimizde SKB hastalarında ömür boyu VDB sıklığının %80 bulunması beklenenden oldukça yüksek gözükebilir. Ancak SKB ile VDB arasındaki pasikopatolojik ilişki ve bu iki durumun birlikte görülmesi halen açıklanmayı bekleyen bir konudur, çünkü beden imgesindeki bozukluk her iki rahatsızlıkta da ortak bir tanısal özelliktir.
Body dysmorphic disorder, trauma, and dissociation inpatients with borderline personality disorder: a preliminary study
Objective: The purpose of this study is to determine the extent ofcomorbid body dysmorphic disorder (BDD) in a group of patients withborderline personality disorder (BPD) and its relation to childhoodtraumatic experiences and dissociation. Method: The study included35 patients (aged 18-42 [year]s) who were consecutively admitted andhad been diagnosed with BPD according to the DSM-IV criteria and 35age and sex matched healthy controls. The subjects were evaluatedwith a comprehensive assessment battery using SCID-I, SCID-II, SCID-like semi-structured interview for BDD, Dissociative Experiences Scale(DES), Somatoform Dissociation Questionnaire (SDQ), TraumaticExperiences Checklist (TEC), and Hamilton Depression Rating Scale(HDRS). Results: The average number of DSM-IV criteria for BPD was7.7 (SD = 1.4) in the study group and 28.5% of them reported childhoodphysical abuse, 28.5% childhood sexual abuse, 8.5% childhoodemotional abuse, 60% childhood neglect. BPD group hadsignificantly higher scores 14% more than one trauma. BPD group hadsignificantly higher scores on the DES (t=26.38; p<0.001), the SDQ(t=20.65; p<0.001), and the TEC (t=4.98; p<0.05) as compared tocontrols. The lifetime prevalence of BDD was 80% in the borderlinesample. For the BPD group, the correlation between BDD diagnosisand childhood trauma history (r=0.099; p>0.05) and dissociationscores (DES r=0.059, p>0.05; DISQ r=0.005, p>0.05) was notsignificant. Conclusions: We have limited data concerning the natureor degree of pathology in individuals with comorbid BPD and BDD. Itis conceivable that some features of BDD and BPD may interface. Thatthe lifetime prevalence of BDD was found 80% in our borderlinesample, may be seen quite greater than expected. But co-occurrenceand pscyhopathological relation between BDD and BPD remains to be clarified, because disturbed body image is a common diagnostic feature in both disorders.

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