Divergences between clinical and research methods for assessing personality disorders: implications for research and the evolution of axis II.
Divergences between clinical and research methods for assessing personality disorders: implications for research and the evolution of axis II.
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DOI：
10.1176/ajp.154.7.895
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发表时间：
1997-07
期刊：
影响因子：
--
通讯作者：
D. Westen
中科院分区：
文献类型：
--
作者：
D. Westen
目的 本研究的目的是检查用于评估轴 II 的仪器与临床诊断过程的偏差程度。方法 第一项研究的受试者是 52 名具有人格障碍患者评估和治疗经验的临床医生，对他们在临床实践中使用的诊断方法和诊断过程的其他方面进行了调查。第二项研究通过全国 1,901 名经验丰富的精神科医生和心理学家的随机样本复制了主要发现。结果 虽然当前的工具主要依赖于 DSM-IV 中衍生的直接问题，但各种理论派别的临床医生都发现直接问题对于评估轴 I 疾病很有用，但对于评估轴 II 的作用却很小。相反，他们通过聆听患者描述人际互动并观察他们与采访者的行为来进行第二轴诊断。与当前研究工具的发现相反，临床实践中大多数人格障碍患者仅接受一项轴 II 诊断，如果他们接受不止一项诊断，则其中一项被认为是原发性的。临床医生报告说，他们治疗了大量现有第二轴仪器无法评估的持久人格模式患者，其中许多既不符合第一轴标准，也不符合第二轴标准，特别是相关性、工作、自尊和慢性亚临床抑郁特征方面的问题。结论 轴 II 的测量是通过使用源自轴 I 仪器的模型构建的，该模型与临床诊断程序不同，这对于人格障碍的评估和更临床和经验上合理的分类法的开发可能存在问题。
OBJECTIVE The purpose of this study was to examine the extent to which instruments for assessing axis II diverge from clinical diagnostic processes. METHOD Subjects in the first study were 52 clinicians with experience in assessment and treatment of patients with personality disorders, who were surveyed about the methods they use in clinical practice to make diagnoses and other aspects of the diagnostic process. A second study replicated the major findings with a random national sample of 1,901 experienced psychiatrists and psychologists. RESULTS Whereas current instruments rely primarily on direct questions derived from DSM-IV, clinicians of every theoretical persuasion found direct questions useful for assessing axis I disorders but only marginally so for axis II. They made axis II diagnoses, instead, by listening to patients describe interpersonal interactions and observing their behavior with the interviewer. In contrast to findings with current research instruments, most patients with personality disorders in clinical practice receive only one axis II diagnosis, and if they receive more than one, one is considered primary. Clinicians reported treating a substantial number of patients for enduring personality patterns that current axis II instruments do not assess, many of which meet neither axis I nor axis II criteria, notably problems with relatedness, work, self-esteem, and chronic subclinical depressive traits. CONCLUSIONS Measurements of axis II were constructed by using a model derived from axis I instruments that diverges from clinical diagnostic procedures in a way that may be problematic for the assessment of personality disorders and the development of a more clinically and empirically sound taxonomy.