Расстройства личности: от исторических аспектов к современным представлениям

В данной статье представлен нарративный обзор ключевых теоретических и клинических подходов к пониманию расстройств личности. Рассматривается историческая эволюция самого понятия, начиная с первых психиатрических описаний и до современных классификаций в рамках DSM-5 и МКБ-11. Обсуждаются различия в определении расстройств личности, а также плюсы и минусы категориальных и дименсиональных систем диагностики. Особое внимание уделяется сопоставлению психодинамического, когнитивно-поведенческого и нейробиологического подходов, включая их влияние на выбор стратегий лечения. В статье подробно анализируются нейробиологические модели личностных расстройств, включая данные о структурных и функциональных изменениях головного мозга, нейрохимических дисбалансах и генетических факторах, а также обсуждаются их потенциал для дальнейшего развития биомаркеров и индивидуализированной терапии. Кроме того, излагаются принципы психотерапевтического лечения в зависимости от теоретической модели: от психоаналитически ориентированной терапии и схема-терапии до диалектической поведенческой терапии. Освещены также возможности и ограничения фармакотерапии, включая современные данные о её эффективности и применимости при различных типах личностной патологии. Обзор направлен на комплексное представление о современном состоянии проблемы и может быть полезен как специалистам в области психиатрии и психотерапии, так и исследователям, интересующимся развитием интегративных моделей диагностики и лечения расстройств личности.

1. Валиуллина Е.В. Изучение и исследование индивидуально-психологических особенностей личности с помощью методики Р.Б. Кеттелла. Фундаментальные научные исследования: теоретические и практические аспекты: Сборник материалов V Международной научно-практической конференции, Том II. – Кемерово: Общество с ограниченной ответственностью "Западно-Сибирский научный центр"; 2017.

2. Ганнушкин П.Б. Клиника психопатий: их статика, динамика, систематика. Н. Новгород: Медицинская книга, 1998.

3. Леонтьев Д.А. Теория личности А.Ф. Лазурского: от наклонностей к отношениям. Методология и история психологии. 2008;3:7–20.

4. Abu Raya M, Ogunyemi AO, Broder J, Carstensen VR, Illanes-Manrique M, Rankin KP. The neurobiology of openness as a personality trait. Front Neurol. 2023;14. https://doi.org/10.3389/fneur.2023.1235345

5. American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. American Journal of Psychiatry. 2001;158:52.

6. Asp M, Lindqvist D, Fernström J, Ambrus L, Tuninger E, Reis M et al. Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care. PLoS One. 2020;15:e0227364. https://doi.org/10.1371/journal.pone.0227364

7. Bach B, Mulder R. Clinical Implications of ICD-11 for Diagnosing and Treating Personality Disorders. Curr Psychiatry Rep. 2022;24:553–63. https://doi.org/10.1007/s11920-022-01364-x

8. Bach B, Sellbom M, Skjernov M, Simonsen E. ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground. Australian & New Zealand Journal of Psychiatry. 2018;52:425–34. https://doi.org/10.1177/0004867417727867

9. Bach B, Simonsen S. How does level of personality functioning inform clinical management and treatment? Implications for ICD-11 classification of personality disorder severity. Curr Opin Psychiatry. 2021;34:54–63. https://doi.org/10.1097/YCO.0000000000000658

10. Bamelis LLM, Evers SMAA, Spinhoven P, Arntz A. Results of a Multicenter Randomized Controlled Trial of the Clinical Effectiveness of Schema Therapy for Personality Disorders. American Journal of Psychiatry. 2014;171:305–22. https://doi.org/10.1176/appi.ajp.2013.12040518

11. Bateman A, Fonagy P. Psychotherapy for Borderline Personality Disorder. Mentalization-based Treatment. Oxford: Oxford University Press; 2004.

12. Bateman AW, Gunderson J, Mulder R. Treatment of personality disorder. The Lancet. 2015;385:735–43. https://doi.org/10.1016/S0140-6736(14)61394-5

13. Choate AM, Fatimah H, Bornovalova MA. Comorbidity in borderline personality: understanding dynamics in development. Curr Opin Psychol. 2021;37:104–8. https://doi.org/10.1016/j.copsyc.2020.09.015

14. Chumakov E, Charnaia D, Petrova N. Pharmacotherapy and psychotherapy interventions in patients with borderline personality disorder in outpatient clinical practice. European Psychiatry. 2024;67:118–118. https://doi.org/10.1192/j.eurpsy.2024.280

15. Clark LA, Watson D. The trait model of the DSM–5 alternative model of personality disorder (AMPD): A structural review. Personality Disorders: Theory, Research, and Treatment. 2022;13:328–36. https://doi.org/10.1037/per0000568

16. Crocq M-A. Milestones in the history of personality disorders. Dialogues Clin Neurosci. 2013;15:147–53. https://doi.org/10.31887/DCNS.2013.15.2/macrocq

17. Deodato M, Seeber M, Mammeri K, Michel CM, Vuilleumier P. Combined effects of neuroticism and negative emotional context on spontaneous EEG dynamics. Soc Cogn Affect Neurosci. 2024;19. https://doi.org/10.1093/scan/nsae012

18. Freud S. Character and anal erotic. London: The Hogarth Press; 1959.

19. Gauchet F, Lambert R. La caracteroiogie d’Heymans et Wiersma. Paris: Presses Universitaires de France; 1959.

20. Huprich SK. Personality Disorders in the ICD-11: Opportunities and Challenges for Advancing the Diagnosis of Personality Pathology. Curr Psychiatry Rep. 2020;22:40. https://doi.org/10.1007/s11920-020-01161-4

21. Jang KL, Livesley WJ, Vernon PA, Jackson DN. Heritability of personality disorder traits: a twin study. Acta Psychiatr Scand. 1996;94:438–44. https://doi.org/10.1111/j.1600-0447.1996.tb09887.x

22. Keefe JR, McMain SF, McCarthy KS, Zilcha-Mano S, Dinger U, Sahin Z, et al. A meta-analysis of psychodynamic treatments for borderline and cluster C personality disorders. Personality Disorders: Theory, Research, and Treatment. 2020;11:157–69. https://doi.org/10.1037/per0000382

23. Kim Y, Saunders GRB, Giannelis A, Willoughby EA, DeYoung CG, Lee JJ. Genetic and neural bases of the neuroticism general factor. Biol Psychol. 2023;184:108692. https://doi.org/10.1016/j.biopsycho.2023.108692

24. Kolla NJ, Boileau I, Bagby RM. Higher trait neuroticism is associated with greater fatty acid amide hydrolase binding in borderline and antisocial personality disorders. Sci Rep. 2022;12:1126. https://doi.org/10.1038/s41598-022-04789-9

25. Koudys JW, Traynor JM, Rodrigo AH, Carcone D, Ruocco AC. The NIMH Research Domain Criteria (RDoC) Initiative and Its Implications for Research on Personality Disorder. Curr Psychiatry Rep. 2019;21:37. https://doi.org/10.1007/s11920-019-1023-2

26. Kraepelin E. Ein Lehrbuch fur Studierende und Artzte. 7. Auflage. II. Band. Klinische Psychiatrie. Leipzig: Verlag Barth; 1904.

27. Krueger RF, Hobbs KA. An Overview of the DSM-5 Alternative Model of Personality Disorders. Psychopathology. 2020;53:126–32. https://doi.org/10.1159/000508538

28. Latzman RD, Krueger RF, DeYoung CG, Michelini G. Connecting quantitatively derived personality–psychopathology models and neuroscience. Personal Neurosci. 2021;4:e4. https://doi.org/10.1017/pen.2021.3

29. Leichsenring F, Rabung S. Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. British Journal of Psychiatry. 2011;199:15–22. https://doi.org/10.1192/bjp.bp.110.082776

30. Leigh D. James Cowles Prichard, M.D., 1786-1848. Proceedings of Royal Society of Medicine. 1955;48:586–90.

31. Livesley W, Jang K, Jackson D, Vernon P. Genetic and environmental contributions to dimensions of personality disorder. American Journal of Psychiatry. 1993;150:1826–31. https://doi.org/10.1176/ajp.150.12.1826

32. Mallard TT, Tubbs JD, Jennings M, Zhang Y, Gustavson DE, Grotzinger AD, et al. The pleiotropic architecture of human impulsivity across biological scales. 2023. https://doi.org/10.1101/2023.11.28.23299133

33. Marstrand-Joergensen MR, Madsen MK, Stenbæk DS, Ozenne B, Jensen PS, Frokjaer VG, et al. Default mode network functional connectivity negatively associated with trait openness to experience. Soc Cogn Affect Neurosci. 2021;16:950–61. https://doi.org/10.1093/scan/nsab048

34. Miller AP, Gizer IR. Dual-systems models of the genetic architecture of impulsive personality traits: neurogenetic evidence of distinct but related factors. Psychol Med. 2024;54:1533–43.

35. Mulder RT. ICD-11 Personality Disorders: Utility and Implications of the New Model. Front Psychiatry. 2021;12. https://doi.org/10.1017/S0033291723003367

36. National Collaborating Centre for Mental Health. National Institute for Health and Clinical Excellence. Personality Disorders: borderline and antisocial. [nice.org]. nice; 2015. Available at: www.nice.org.uk/guidance/qs88. 2015.

37. National Health and Medical Research Council. Australian Government. Clinical Practice guidelines for the management of borderline personalità disorder. Melbourne: National Health and Medical Research Council. [bpdfoundation.org.au]. bpdfoundation; 2012. Available at: https://bpdfoundation.org.au/images/mh25_borderline_personality_guideline.pdf

38. Ormel J, Bastiaansen A, Riese H, Bos EH, Servaas M, Ellenbogen M, et al. The biological and psychological basis of neuroticism: Current status and future directions. Neurosci Biobehav Rev. 2013;37:59–72. https://doi.org/10.1016/j.neubiorev.2012.09.004

39. Paris J. Why Patients With Severe Personality Disorders Are Overmedicated. J Clin Psychiatry. 2015;76:e521–e521. https://doi.org/10.4088/JCP.14com09441

40. Pascual JC, Arias L, Soler J. Pharmacological Management of Borderline Personality Disorder and Common Comorbidities. CNS Drugs. 2023;37:489–97. https://doi.org/10.1007/s40263-023-01015-6

41. Pinel P. Traité médico-philosophique sur I’aliénation mentale ou la manie. Paris, 1801.

42. Post RM, Leverich GS, McElroy S, Kupka R, Suppes T, Altshuler L, et al. Relationship of comorbid personality disorders to prospective outcome in bipolar disorder. J Affect Disord. 2020;276:147–51. https://doi.org/10.1016/j.jad.2020.07.031

43. Ribot T. La psychologie des sentiments. Paris; 1896.

44. Rinaldi C, Attanasio M, Valenti M, Mazza M, Keller R. Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis. World J Psychiatry. 2021;11:1366–86. https://doi.org/10.5498/wjp.v11.i12.1366

45. Ripoll LH, Triebwasser J, Siever LJ. Evidence-based pharmacotherapy for personality disorders. Int J Neuropsychopharmacol. 2011;14:1257–88. https://doi.org/10.1017/S1461145711000071

46. Schneider K. Klinische Psychopathologie. Stuttgart, 1976.

47. Siever L, Davis K. A psychobiological perspective on the personality disorders. American Journal of Psychiatry. 1991;148:1647–58. https://doi.org/10.1176/ajp.148.12.1647

48. Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews. 2010. https://doi.org/10.1002/14651858.CD005653.pub2.

49. Stoffers-Winterling JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews. 2012;8(8):CD005652 https://doi.org/10.1002/14651858.CD005652.pub2

50. Stoffers-Winterling J, Storebø OJ, Lieb K. Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies. Curr Psychiatry Rep. 2020;22:37. https://doi.org/10.1007/s11920-020-01164-1

51. Stoffers-Winterling J, Völlm B, Lieb K. Is pharmacotherapy useful for treating personality disorders? Expert Opin Pharmacother. 2021;22:393–5. https://doi.org/10.1080/14656566.2021.1873277

52. Svrakic D, Cloninger R. Psychobiological Model of Personality: Guidelines for Pharmacotherapy of Personality Disorder. Curr Psychopharmacol. 2013;2:190–203.

53. Swales MA. Personality disorder diagnoses in ICD-11: Transforming conceptualisations and practice. Clinical Psychology in Europe. 2022;4 Special Issue. https://doi.org/10.32872/cpe.9635

54. Tyrer P, Gunderson J, Lyons M, Tohen M. Special Feature: Extent of Comorbidity Between Mental State and Personality Disorders. J Pers Disord. 1997;11:242–59. https://doi.org/10.1521/pedi.1997.11.3.242

55. Xu Q, Liu F, Qin W, Jiang T, Yu C. Multiscale neurobiological correlates of human neuroticism. Hum Brain Mapp. 2020;41:4730–43. https://doi.org/10.1002/hbm.25153sto