Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health's Research Domain Criteria (RDoC)
Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health's Research Domain Criteria (RDoC)
复制标题
DOI：
10.1177/1529100617727266
复制
发表时间：
2017-09-01
影响因子：
25.4
通讯作者：
Reed, Geoffrey M.
中科院分区：
文献类型：
--
作者：
Clark, Lee Anna;Cuthbert, Bruce;Reed, Geoffrey M.
精神障碍的诊断最初似乎相对简单：患者出现症状或明显的疾病迹象；卫生专业人员主要根据这些症状和体征进行诊断;他们会相应地开一些药物，心理治疗，或者两者兼而有之。然而，尽管在过去的半个世纪里，关于精神障碍的知识有了戏剧性的扩展，但对其组成部分和过程的理解仍然是初级的。我们提供了三个系统的历史和描述，它们具有不同的目的，与理解和分类精神障碍有关。两本主要的诊断手册《国际疾病分类》和《精神障碍诊断与统计手册》提供了与公共卫生、临床诊断、服务提供和具体研究应用相关的分类系统，前者是国际分类，后者主要针对美国。相比之下，国家心理健康研究所的研究领域标准提供了一个框架，强调基本行为和神经科学研究的整合，以加深对精神障碍的理解。我们确定了对理解和分类精神障碍提出挑战的四个关键问题：病因学，包括精神障碍的多重因果关系；相关现象是离散的类别还是维度；阈值，设定无序和非无序之间的界限；还有共病，精神疾病患者通常符合多种疾病的诊断要求。我们将讨论这三种体系处理这些关键问题的方法是如何由于它们不同的历史、目的和选区而对应或分歧的。虽然这些系统有不同程度的重叠和不同的特点，但它们都有一个共同的目标，即减轻精神障碍造成的痛苦负担。
The diagnosis of mental disorder initially appears relatively straightforward: Patients present with symptoms or visible signs of illness; health professionals make diagnoses based primarily on these symptoms and signs; and they prescribe medication, psychotherapy, or both, accordingly. However, despite a dramatic expansion of knowledge about mental disorders during the past half century, understanding of their components and processes remains rudimentary. We provide histories and descriptions of three systems with different purposes relevant to understanding and classifying mental disorder. Two major diagnostic manualsthe International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disordersprovide classification systems relevant to public health, clinical diagnosis, service provision, and specific research applications, the former internationally and the latter primarily for the United States. In contrast, the National Institute of Mental Health's Research Domain Criteria provides a framework that emphasizes integration of basic behavioral and neuroscience research to deepen the understanding of mental disorder. We identify four key issues that present challenges to understanding and classifying mental disorder: etiology, including the multiple causality of mental disorder; whether the relevant phenomena are discrete categories or dimensions; thresholds, which set the boundaries between disorder and nondisorder; and comorbidity, the fact that individuals with mental illness often meet diagnostic requirements for multiple conditions. We discuss how the three systems' approaches to these key issues correspond or diverge as a result of their different histories, purposes, and constituencies. Although the systems have varying degrees of overlap and distinguishing features, they share the goal of reducing the burden of suffering due to mental disorder.