Three-pronged assessment and diagnosis of personality disorder and its consequences: personality functioning, pathological traits, and psychosocial disability.
Three-pronged assessment and diagnosis of personality disorder and its consequences: personality functioning, pathological traits, and psychosocial disability.
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DOI：
10.1037/per0000063
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发表时间：
2014-01
影响因子：
2.8
通讯作者：
Ro, Eunyoe
中科院分区：
文献类型：
--
作者：
Clark, Lee Anna;Ro, Eunyoe
关键词：
《精神障碍诊断与统计手册》第五版（DSM-5）第 III 部分中的人格障碍（PD）替代维度模型有两个主要标准：人格功能受损和一种或多种病理性人格特征。前者被定义为自我功能（即身份、自我导向）和/或人际功能（即同理心、亲密关系）的障碍。区分人格功能和特征在概念上很重要，因为仅仅具有极端特征并不一定是病态的。然而，将人格功能添加到帕金森病诊断中是一个实证挑战，因为这些结构在概念上是重叠的。此外，关于精神障碍的诊断是否需要痛苦或残疾存在争议，这些概念也与适应不良范围的人格特征和人格功能障碍重叠。我们使用社区-患者混合样本 (N = 402) 中每个领域的多项自我报告测量来研究这些结构之间的相互关系。我们首先独立地，然后联合地检查功能结构（心理社会残疾和人格）和人格特征。残疾/功能测量产生了我们之前发现的三个维度。特质测量具有层次结构，在五因素水平上反映了神经质/负面情感（N/NA）、（低）社交性、去抑制性、（不）宜人性和严格的目标参与度。当所有的衡量指标被共同考虑时，一个层次结构再次出现，在五个因素的水平上，包括（1）内化（N/NA和自我病理与生活质量/满意度），（2）外化（社交/人际功能障碍，社交能力低和不愉快），（3）去抑制，（4）基本功能差，以及（5）严格的目标参与。我们通过开发集成的 PD 诊断模型来讨论结果。
The alternative dimensional model of personality disorder (PD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Section III, has two main criteria: Impairment in personality functioning and one or more pathological personality traits. The former is defined as disturbances in self functioning (viz., identity, self-direction), and/or interpersonal functioning (viz., empathy, intimacy). Distinguishing personality functioning and traits is important conceptually, because simply having extreme traits is not necessarily pathological. However, adding personality functioning to PD diagnosis represents an empirical challenge, because the constructs overlap conceptually. Further, there is debate regarding whether diagnosis of mental disorder requires either distress or disability, concepts that also overlap with maladaptive-range personality traits and personality dysfunction. We investigated interrelations among these constructs using multiple self-report measures of each domain in a mixed community-patient sample (N = 402). We examined the structures of functioning (psychosocial disability and personality), and personality traits, first independently, then jointly. The disability/functioning measures yielded the three dimensions we have found previously. Trait measures had a hierarchical structure which, at the five-factor level, reflected neuroticism/negative affectivity (N/NA), (low) sociability, disinhibition, (dis)agreeableness, and rigid goal engagement. When all measures were co-factored, a hierarchical structure again emerged which, at the five-factor level, included (1) internalizing (N/NA and self-pathology vs. quality-of-life/satisfaction), (2) externalizing (social/interpersonal dysfunction, low sociability, and disagreeableness), (3) disinhibition, (4) poor basic functioning, and (5) rigid goal engagement. Results are discussed in terms of developing an integrated PD diagnostic model.
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