Пограничное расстройство личности - идентификация, коморбидность и новые возможности лечения



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Аннотация

В статье анализируются диагностические критерии пограничного расстройства личности (ПРЛ) в рамках DSM-5 и МКБ-11. Феноменология коморбидности пограничного и аддиктивного расстройства рассматривается, как взаимопроникающая симптоматика, усугубляющая совокупную динамику. Приводится краткий обзор современных подходов к лечению с акцентом на потенциальных возможностях кетаминовой терапии. Обсуждаются результаты собственного ретроспективного открытого исследования лечения 18 пациентов с двойным (ПРЛ + расстройство вследствие употребления алкоголя/кокаина) и тройным (ПРЛ + расстройство вследствие употребления алкоголя/кокаина + депрессия) диагнозом с использованием кетамина. Новые подходы позволяют пересмотреть традиционный терапевтический нигилизм в отношении ПРЛ.

 

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Об авторах

Михаил Леонидович Зобин

Автор, ответственный за переписку.
Email: dr.zobin@gmail.com
ORCID iD: 0000-0002-8239-3770

Список литературы

  1. 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington: American Psychiatric Association, 2013.
  2. 2. Leichsenring F, Fonagy P, Heim N. et al. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry. 2024 Feb;23(1):4-25. doi: 10.1002/wps.21156.
  3. 3. WHO. ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders. Geneva: World Health Organisation; 2022
  4. 4. Bach, B., Kramer, U., Doering, S. et al. The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities. Bord personal disord emot dysregul 9, 12 (2022). https://doi.org/10.1186/s40479-022-00182-0
  5. 5. Bohus M, Stoffers-Winterling J, Sharp C, et al. Borderline personality disorder. Lancet. 2021 Oct 23;398(10310):1528-1540. doi: 10.1016/S0140-6736(21)00476-1. PMID: 34688371.
  6. 6. Gunderson JG, Herpertz SC, Skodol AE et al. Borderline personality disorder. Nat Rev Dis Primers 2018;4:18029.
  7. 7. Shah R, Zanarini MC. Comorbidity of borderline personality disorder: current status and future directions. Psychiatr Clin N Am. 2018; 41(4):583–93. doi.org/10.1016/j.psc.2018.07.009
  8. 8. Szerman N., Peris L. Personality Disorders and Addiction Disorders //In Textbook of Addiction Treatment: International Perspectives (pp.2063-2083) November 2015 doi: 10.1007/978-88-470-5322-9_120
  9. 9. Trull TJ, Freeman LK, Vebares TJ, Choate AM, Helle AC, Wycoff AM. Borderline personality disorder and substance use disorders: an updated review. Borderline Personal Disord Emot Dysregul. 2018 Sep 19;5:15. doi: 10.1186/s40479-018-0093-9. PMID: 30250740; PMCID: PMC6145127.
  10. 10. Stetsiv K, McNamara IA, Nance M, Carpenter RW. The Co-occurrence of Personality Disorders and Substance Use Disorders. Curr Psychiatry Rep. 2023 Nov;25(11):545-554. doi: 10.1007/s11920-023-01452-6. Epub 2023 Oct 3. PMID: 37787897; PMCID: PMC10798162.
  11. 11. Szerman N, Torrens M, Maldonado R, et al. World Association on Dual Disorders (WADD). Addictive and other mental disorders: a call for a standardized definition of dual disorders. Transl Psychiatry. 2022 Oct 13;12(1):446. doi: 10.1038/s41398-022-02212-5. PMID: 36229453; PMCID: PMC9562408.
  12. 12. Мареммани А., Мареммани И. Следует ли признать существование психопатологии, характерной для зависимости // Неврологический вестник. 2025. Т. 57, № 1. С. 5–11. doi: 10.17816/nb637368
  13. 13. Chapman J, Jamil RT, Fleisher C, Torrico TJ. Borderline Personality Disorder. 2024 Apr 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 28613633.
  14. 14. Trull TJ, Jahng S, Tomko RL, et al. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord. 2010 Aug;24(4):412-26. doi: 10.1521/pedi.2010.24.4.412. PMID: 20695803; PMCID: PMC3771514.
  15. 15. Parmar A, Kaloiya G. Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review. Indian J Psychol Med. 2018 Nov-Dec;40(6):517-527. doi: 10.4103/IJPSYM.IJPSYM_164_18.
  16. 16. Jahng S, Trull TJ, Wood PK, et al. Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity. J Abnorm Psychol. 2011 Aug;120(3):656-69. doi: 10.1037/a0023539.
  17. 17. Fraser R., Isaif L., Teles D., Laporte, L. (2021). Personality Disorders and Addiction Disorders. In: el-Guebaly, N., Carrà, G., Galanter, M., Baldacchino, A.M. (eds) Textbook of Addiction Treatment. Springer, Cham. doi: 10.1007/978-3-030-36391-8_96.
  18. 18. Mulder RT, Horwood LJ, Tyrer P. The borderline pattern descriptor in the International Classification of Diseases, 11th Revision: A redundant addition to classification. Aust N Z J Psychiatry. 2020 Nov;54(11):1095-1100. doi: 10.1177/0004867420951608.
  19. 19. Gutiérrez F, Aluja A, Ruiz Rodríguez J, et al. Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11). Personal Disord. 2023 May;14(3):355-359. doi: 10.1037/per0000592
  20. 20. Caspi A, Houts RM, Belsky DW, et al. The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders? Clin Psychol Sci. 2014 Mar;2(2):119-137. doi: 10.1177/2167702613497473.
  21. 21. Gluschkoff K, Jokela M, Rosenström T. General psychopathology factor and borderline personality disorder: Evidence for substantial overlap from two nationally representative surveys of U.S. adults. Personal Disord. 2021 Jan;12(1):86-92. doi: 10.1037/per0000405.
  22. 22. Sharp C, Wall K. DSM-5 Level of Personality Functioning: Refocusing Personality Disorder on What It Means to Be Human. Annu Rev Clin Psychol. 2021 May 7;17:313-337. doi: 10.1146/annurev-clinpsy-081219-105402.
  23. 23. Zanarini MC, Temes CM, Frankenburg FR, et al. Description and prediction of time-to-attainment of excellent recovery for borderline patients followed prospectively for 20 years. Psychiatry Res. 2018 Apr;262:40-45. doi: 10.1016/j.psychres.2018.01.034.
  24. 24. Клинические рекомендации - Специфические расстройства личности – 2024–2025-2026 (23.08.24) – Утверждены Минздравом РФ.
  25. 25. National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management – Clinical guideline. London: National Institute for Health and Care Excellence, 2009
  26. 26. Simonsen S., Bateman A., Bohus M. et al. European guidelines for personality disorders: past, present and future. Borderline Personal Disord Emot Dysregul. 2019 May 21;6:9. doi: 10.1186/s40479-019-0106-3.
  27. 27. Cristea IA, Gentili C, Cotet CD, et al. Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2017 Apr 1;74(4):319-328. doi: 10.1001/jamapsychiatry.2016.4287.
  28. 28. Smits ML, Luyten P, Feenstra DJ, et al. Trauma and Outcomes of Mentalization-Based Therapy for Individuals With Borderline Personality Disorder. Am J Psychother. 2022 Jan 1;75(1):12-20. doi: 10.1176/appi.psychotherapy.20210027.
  29. 29. Setkowski K, Palantza C, van Ballegooijen W, et al. Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis. Psychol Med. 2023 Jun;53(8):3261-3280. doi: 10.1017/S0033291723000685.
  30. 30. Woodbridge J, Townsend M, Reis S, et al. Non-response to psychotherapy for borderline personality disorder: A systematic review. Aust N Z J Psychiatry. (2022) 56:771–87. doi: 10.1177/00048674211046893
  31. 31. Gartlehner G, Crotty K, Kennedy S, et al. Pharmacological treatments for borderline personality disorder: A systematic review and meta-analysis. CNS Drugs. (2021) 35:1053–67. doi: 10.1007/s40263-021-00855-4
  32. 32. Stoffers J, Völlm BA, Rücker G, et al. Pharmacological interventions for borderline personality disorder. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD005653. doi: 10.1002/14651858.CD005653.pub2.
  33. 33. Pascual JC, Arias L, Soler J. Pharmacological Management of Borderline Personality Disorder and Common Comorbidities. CNS Drugs. 2023 Jun;37(6):489-497. doi: 10.1007/s40263-023-01015-6.
  34. 34. Yavi M., Lee H., Henter I.D. et al. Ketamine treatment for depression: a review. Discov Ment Health 2, 9 (2022). doi.org/10.1007/s44192-022-00012-3
  35. 35. Jones JL, Mateus CF, Malcolm RJ,et al. Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review. Front Psychiatry. 2018 Jul 24;9:277. doi: 10.3389/fpsyt.2018.00277.
  36. 36. Dakwar E, Nunes EV, Hart CL, et al. A sub-set of psychoactive effects may be critical to the behavioral impact of ketamine on cocaine use disorder: Results from a randomized, controlled laboratory study. Neuropharmacology. (2018) 142:270–6. doi: 10.1016/j.neuropharm.2018.01.005
  37. 37. Walsh Z, Mollaahmetoglu OM, Rootman J, et al. Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych Open. 2021 Dec 23;8(1):e19. doi: 10.1192/bjo.2021.1061.
  38. 38. Drozdz SJ, Goel A, McGarr MW, et al. Ketamine assisted psychotherapy: A systematic narrative review of the literature. J Pain Res. (2022) 15:1691–706. doi: 10.2147/JPR.S360733.
  39. 39. Danayan K, Chisamore N, Rodrigues NB, et al. Real world effectiveness of repeated ketamine infusions for treatment-resistant depression with comorbid borderline personality disorder. Psychiatry Res. (2023) 323:115133. doi: 10.1016/j.psychres.2023.115133
  40. 40. McIntyre RS, Lipsitz O, Rodrigues NB, et al. The effectiveness of ketamine on anxiety, irritability, and agitation: Implications for treating mixed features in adults with major depressive or bipolar disorder. Bipolar Disord. (2020) 22:831–40. doi: 10.1111/bdi.12941
  41. 41. Grunebaum MF, Galfalvy HC, Choo TH, et al. Ketamine for rapid reduction of suicidal thoughts in major depression: A midazolam controlled randomized clinical trial. Am J Psychiatry. (2018) 175:327–35. doi: 10.1176/ appi.ajp.2017.17060647
  42. 42. Lengvenyte A, Olie E, Courtet P. Suicide has many faces, so does ketamine: a narrative review on Ketamine's antisuicidal actions. Curr Psychiatry Rep. (2019) 21:132. doi: 10.1007/s11920-019-1108-y
  43. 43. Nandan NK, Soni PK, Parsaik A, Hashmi A. "Esketamine" in Borderline Personality Disorder: A Look Beyond Suicidality. Cureus. 2022 Apr 30;14(4):e24632. doi: 10.7759/cureus.24632.
  44. 44. Rogg H, Avram M, Müller F, Junghanns K, Borgwardt S, Zurowski B. Ketamine as a treatment option for severe borderline personality disorder: a case report. J Clin Psychopharmacol. 2023;43:64–65. doi: 10.1097/JCP.0000000000001642.
  45. 45. Fineberg SK, Choi EY, Shapiro-Thompson R, et al. A pilot randomized controlled trial of ketamine in Borderline Personality Disorder. Neuropsychopharmacology. 2023 Jun;48(7):991-999. doi: 10.1038/s41386-023-01540-4.
  46. 46. Więdłocha M, Marcinowicz P, Komarnicki J, et al. Depression with comorbid borderline personality disorder - could ketamine be a treatment catalyst? Front Psychiatry. 2024 Apr 29;15:1398859. doi: 10.3389/fpsyt.2024.1398859.
  47. 47. Wöller W, Huppertz BJ. Borderline--eine diagnostische Einheit? [Borderline--a diagnostic entity?]. Fortschr Neurol Psychiatr. 1984 Oct;52(10):338-45. German. doi: 10.1055/s-2007-1002031.
  48. 48. Vanicek T, Unterholzner J, Lanzenberger R, et al. Intravenous esketamine leads to an increase in impulsive and suicidal behaviour in a patient with recurrent major depression and borderline personality disorder. World J Biol Psychiatry. 2022 Nov;23(9):715-718. doi: 10.1080/15622975.2022.2031287.
  49. 49. Krupitsky E, Burakov A, Romanova T, Dunaevsky I, Strassman R, Grinenko A. Ketamine psychotherapy for heroin addiction: immediate effects and two-year followup. J Subst Abuse Treat. (2002) 23:273–83. doi: 10.1016/S0740-5472(02)00275-1
  50. 50. Rothberg RL, Azhari N, Haug NA, Dakwar E. Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: Results from a randomized, controlled trial. J Psychopharmacol. (2021) 35:150–8. doi: 10.1177/0269881120970879
  51. 51. Chiappini S, d'Andrea G, De Filippis S, et al. Esketamine in treatment-resistant depression patients comorbid with substance-use disorder: A viewpoint on its safety and effectiveness in a subsample of patients from the REAL-ESK study. Eur Neuropsychopharmacol. (2023) 74:15–21. doi: 10.1016/j.euroneuro.2023.04.01 145.
  52. 52. Mollaahmetoglu OM, Keeler J, Ashbullby KJ, et al. (2021) “This is something that changed my life”: A qualitative study of patients’ experiences in a clinical trial of ketamine treatment for alcohol use disorders. Front Psychiatry 12: 695335. doi: 10.3389/fpsyt.2021.695335
  53. 53. Nielson EM, May DG, Forcehimes AA, Bogenschutz MP. The Psychedelic Debriefing in Alcohol Dependence Treatment: Illustrating Key Change Phenomena through Qualitative Content Analysis of Clinical Sessions. Front Pharmacol. 2018 Feb 21;9:132. doi: 10.3389/fphar.2018.00132.
  54. 54. Hutsebaut J, Bender DS. The Clinical Utility of the Level of Personality Functioning Scale: A Treatment Perspective. J Psychiatr Pract. 2024 Nov 1;30(6):411-420. doi: 10.1097/PRA.0000000000000822.
  55. 55. Kleindienst N, Jungkunz M, Bohus M. A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23). Borderline Personal Disord Emot Dysregul. 2020 Jun 1;7(1):11. doi: 10.1186/s40479-020-00126-6. Erratum in: Borderline Personal Disord Emot Dysregul. 2022 Jan 21;9(1):4. doi: 10.1186/s40479-021-00174-6.
  56. 56. Unoka Z, Csáky-Pallavicini K, Horváth Z, et al. The Inventory of Personality Organization: A valid instrument to detect the severity of personality dysfunction. Front Psychiatry. 2022 Nov 10;13:995726. doi: 10.3389/fpsyt.2022.995726.
  57. 57. Gren J, Gorman I, Ruban A, et al. Call for evidence-based psychedelic integration. Exp Clin Psychopharmacol. (2024) 32(2):129–35. doi: 10.1037/pha0000684
  58. 58. Iliakis EA, Ilagan GS, Choi‐Kain LW. Dropout rates from psychotherapy trials for borderline personality disorder: a meta‐analysis. Personal Disord 2021;12:193‐206.
  59. 59. Leichsenring F, Sarrar L, Steinert C. Drop-outs in psychotherapy: a change of perspective. World Psychiatry. 2019 Feb;18(1):32-33. doi: 10.1002/wps.20588.
  60. 60. Sicorello M, Schmahl C. Emotion dysregulation in borderline personality disorder: A fronto-limbic imbalance? Curr Opin Psychol. 2021 Feb;37:114-120. doi: 10.1016/j.copsyc.2020.12.002.
  61. 61. Romeo B, Hermand M, Pétillion A, et al. Clinical and biological predictors of psychedelic response in the treatment of psychiatric and addictive disorders: A systematic review. J Psychiatr Res. 2021 May;137:273-282. doi: 10.1016/j.jpsychires.2021.03.002.
  62. 62. Varela F, Thompson E, Rosch E. The Embodied Mind: Cognitive Science and Human Experience MIT Press (1993) - 308p.
  63. 63. Davidson D. Essay 13. The material mind //Essays on Actions and Events - Second edition. — Oxford University Press, 2001. - 346 p.
  64. 64. Tyrer P, Mulder R, Kim YR, Crawford MJ. The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics. Annu Rev Clin Psychol. 2019 May 7;15:481-502. doi: 10.1146/annurev-clinpsy-050718-095736.

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