Convergence between DSM-IV-TR and DSM-5 Diagnostic Models for Personality Disorder: Evaluation of Strategies for Establishing Diagnostic Thresholds
Convergence between DSM-IV-TR and DSM-5 Diagnostic Models for Personality Disorder: Evaluation of Strategies for Establishing Diagnostic Thresholds
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DOI：
10.1097/01.pra.0000430502.78833.06
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发表时间：
2013-05-01
影响因子：
1.9
通讯作者：
Skodol, Andrew E.
中科院分区：
文献类型：
--
作者：
Morey, Leslie C.;Skodol, Andrew E.
精神障碍诊断与统计手册第五版人格与人格障碍工作组（The Personality and Personality Disorders Work Group for the Diagnostic and Statistical Manual of Mental Disorders，Fifth Edition，DSM-5）建议对DSM-IV-TR的人格障碍部分进行实质性修订，提出了一种混合分类维度模型，将人格障碍表示为核心人格功能障碍和各种适应不良人格特征的组合。虽然DSM-5工作组认可了这一提议，但美国精神病学协会（阿帕）董事会并没有认可，而是将工作组的模型与其他被认为需要进一步研究的概念一起放在DSM-5第三部分（“新兴措施和模型”）中。本文记录了使用这种替代模型的影响，在全国样本的337例患者所描述的临床医生熟悉他们的情况。特别是，分析的重点是工作组考虑的替代战略，以得出决策规则，或诊断阈值，分配分类诊断。结果表明，诊断规则可以得出，DSM-IV-TR和建议的DSM-5 PD诊断之间产生可观的对应关系，对应关系大于DSM-III和DSM-III-R PD之间的过渡中观察到的。该方法也代表了迄今为止最全面的尝试，为DSM PD中使用的诊断阈值提供概念和经验依据。（Journal of Psychiatric Practice 2013;19：179-193）
The Personality and Personality Disorders Work Group for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recommended substantial revisions to the personality disorders (PDs) section of DSM-IV-TR, proposing a hybrid categorical-dimensional model that represented PDs as combinations of core personality dysfunctions and various configurations of maladaptive personality traits. Although the DSM-5 Task Force endorsed the proposal, the Board of Trustees of the American Psychiatric Association (APA) did not, placing the Work Group's model in DSM-5 Section III ("Emerging Measures and Models") with other concepts thought to be in need of additional research. This paper documents the impact of using this alternative model in a national sample of 337 patients as described by clinicians familiar with their cases. In particular, the analyses focus on alternative strategies considered by the Work Group for deriving decision rules, or diagnostic thresholds, with which to assign categorical diagnoses. Results demonstrate that diagnostic rules could be derived that yielded appreciable correspondence between DSM-IV-TR and proposed DSM-5 PD diagnoses-correspondence greater than that observed in the transition between DSM-III and DSM-III-R PDs. The approach also represents the most comprehensive attempt to date to provide conceptual and empirical justification for diagnostic thresholds utilized within the DSM PDs. (Journal of Psychiatric Practice 2013;19:179-193)