Nicht-suizidale Selbstverletzung als eigenständige Diagnose
Implikationen des DSM-5 Vorschlages für Forschung und Klinik selbstverletzenden Verhaltens bei Jugendlichen
Abstract
Selbstverletzendes Verhalten stellt in den Klassifikationssystemen DSM-IV-TR und ICD-10 ein Symptom der Borderline Persönlichkeitsstörung (BPS) dar. In den letzten Jahren konnte empirisch gezeigt werden, dass selbstverletzendes Verhalten auch unabhängig von einer BPS etwa bei depressiven Störungen oder auch bei Jugendlichen ohne klassifizierbare Psychopathologie auftritt. Die wissenschaftliche Diskussion um eine eigenständige diagnostische Kriterienbildung für dieses Phänomen führte nun zu einem Vorschlag zur Neuaufnahme einer Diagnose mit der Bezeichnung «Nicht-suizidale Selbstverletzung» in das sich in Entwicklung befindliche DSM-5. Vor dem Hintergrund aktueller Untersuchungen zur Häufigkeit selbstverletzenden Verhaltens bei Jugendlichen in Deutschland kann davon ausgegangen werden, dass ca. 4 % der Jugendlichen im mittleren und späten Adoleszenzalter das Kriterium A (mindestens fünf selbstverletzende Handlungen in den vorausgegangenen 12 Monaten) der vorgeschlagenen Störung im DSM-5 erfüllen. Eine auf empirische Untersuchungen basierende Klassifikation selbstverletzender Handlungen wird sowohl für die Forschung, wie auch für die Behandlung und zur Implementierung von Präventionsmaßnahmen hilfreich sein.
In both classificatory systems DSM-IV and ICD-10 self-injury is a symptom of borderline personality disorder (BPD). But it has been shown empirically that self-injury can also occur independent of BPD, for example, as a component of depressive states or even in adolescents without classifiable psychopathology. The scientific discussion about future diagnostic criteria recently led to a proposal to include Non-Suicidal Self-Injury as an independent disorder in the upcoming DSM-5 classification system. Based on recent epidemiological studies of adolescents in Germany, one may assume that approximately 4% of all youths in middle to late adolescence would fulfill the prevalence criterion (criterion A) of the proposed DSM-5 disorder (that is, at least five self-injury incidents within the previous 12 months). A precise classification of Non-Suicidal Self-Injury based on empirical research is needed to further the research, treatment, and prevention of this diagnosis.
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