Komorbide Angststörungen bei Störungen des Sozialverhaltens : Ein Schutz- oder Risikofaktor?

Abstract

Zusammenfassung. Obwohl Angststörungen (AS) häufig komorbid mit einer Störung des Sozialverhaltens (SSV) auftreten, wurde diese Komorbidität in der Forschung weitgehend vernachlässigt. Komorbide AS wirken sich in Studien sowohl positiv als auch negativ auf den Verlauf einer SSV aus. Diese Studie zielt darauf ab, Heranwachsende mit einer SSV mit und ohne AS hinsichtlich psychischer Belastung, traumatischen Erlebnissen, psychopathischen Persönlichkeitstraits und Legalbewährung zu untersuchen. 207 Heranwachsende mit einer SSV (9 – 25 Jahre; 73.4 % männlich; SSV: N = 180, SSV und AS: N = 27), die zum Zeitpunkt der Untersuchung in Jugendhilfeeinrichtungen lebten, konnten eingeschlossen werden. Es wurden strukturierte klinische Interviews und eine psychometrische Testbatterie eingesetzt. Die Resultate zeigen, dass die Gruppe mit SSV und AS signifikant weniger externalisierende und mehr internalisierende Symptome sowie traumatische Erlebnisse aufweisen. Bezüglich psychopathischer Persönlichkeitsmerkmale und Verurteilungen (>50 % in beiden Gruppen) ergaben sich keine signifikanten Gruppenunterschiede. Die Ergebnisse legen nahe, dass die Ausprägung der SSV für die Kriminalitätsentwicklung bedeutsamer und die spezifische Komorbidität von AS aber doch ätiologisch und symptomatisch von großem Interesse ist. Diese sollte deshalb mit Längsschnittstudien und Therapieprozessanalysen intensiver beforscht werden.

Comorbid Anxiety Disorders Among Youth With Conduct Disorder: Protective or Risk Factor?

Abstract. Although it has been shown that anxiety disorders (AD) are often found in children and juveniles with a disruptive behavior disorder (DBD; i. e., conduct disorder [CD] and oppositional defiant disorder [ODD]), research in this field is limited. The few papers that addressed this topic found indications for both positive and negative effects of AD on the course and treatment of DBD. The objective of the current study was to examine mental health problems, traumatic experiences, psychopathic traits, and offending behavior in juveniles and emerging adults with DBD with AD compared with those without AD. The total sample contained 207 children, adolescents, and emerging adults (age 9 – 25, 73.4 % males) with DBD with AD ( N = 27) and with DBD without AD ( N = 180) in residential youth care institutions in Switzerland between 2007 and 2011. Half of the sample was placed under civil law (50.5 %), 37.8 % under penal law, and 11.7 % for other reasons (e. g., voluntarily). Psychopathology was examined with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime version (K-SADS-PL), a semistructured interview for mental disorders. In addition, mental health problems were assessed using the Massachusetts Youth Screening Instrument-second version (MAYSI-2), traumatic experiences with the Essener Trauma-Inventar (ETI), and psychopathic traits using the Youth Psychopathic Traits Inventory (YPI). Finally, conviction rates were requested at the Federal Statistical Office. Results showed that the group with DBD and AD comprised significantly more female subjects than did the DBD without AD group, 48.1 % vs. 77.2 %; χ ²(1, N = 207) = 10.17, p < 0.01. Both groups did not differ on age, time of measure, drop-out, or previous placements. Furthermore, the DBD with AD group had significantly less additional externalizing disorders than the group without AD, 11.1 % vs. 38.3 %; χ ²(1, N = 207) = 7.67, p < 0.01. No significant differences between both groups were found for internalizing disorders or substance use disorders. The DBD with AD group, however, reported significantly more depressed–anxious problems, t(231) = -2.19, p = .030, somatic complaints t(231) = -3.34, p = .001, and suicide ideation, t(231) = -2.13, p = .034, as well as more traumatic experiences, 100.0 % vs. 83.0 %; χ ²(1, N = 207) = 4.39, p = 0.04, than did the DBD group without AD. Finally, no differences were found between the two groups for psychopathic traits and both conviction and reconviction rates. The results of the current study demonstrate that although the group of juveniles with DBD and AD in residential youth care institutions in Switzerland is burdened differently than those juveniles with DBD without AD (fewer externalizing problems, more traumatic experiences, more internalizing problems), they are not at increased or decreased risk for being convicted or reconvicted. More longitudinal research, however, is needed to understand the relationship between DBD and comorbid AD.