Personality diagnoses in adolescence: DSM-IV axis II diagnoses and an empirically derived alternative
Personality diagnoses in adolescence: DSM-IV axis II diagnoses and an empirically derived alternative
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DOI：
10.1176/appi.ajp.160.5.952
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发表时间：
2003-05-01
影响因子：
17.7
通讯作者：
Martens, A
中科院分区：
文献类型：
--
作者：
Westen, D;Shedler, J;Martens, A
目的：青少年人格病理学的研究尚处于起步阶段。本文考察了DSM-IV第11轴人格障碍诊断在青少年中的适用性和局限性，评估了一种评估青少年人格病理学方法的有效性，并开始发展一种基于经验的分类。方法：共有296名随机选择的临床医生使用11轴评定量表和青少年谢勒-韦斯顿评估程序-200 (SWAP-200-A)（一种用于评估青少年人格病理的q分类工具）描述了一名14-18岁的治疗适应不良人格模式的患者。在检查了样本中11轴疾病的性质和频率之后，作者使用q因子分析来确定基于共同人格特征的自然发生的患者分组。结果：青少年的轴11诊断与成人相似，尽管DSM-IV标准的应用似乎过度诊断了青少年的反社会和回避型人格障碍。用swap - 200a进行Q分析，分离出五种人格障碍（反社会精神病、情绪失调、逃避型、自恋型和戏剧型）和一种人格类型。患者在每个诊断原型上的维度得分与当前11轴障碍的评分、适应功能的测量和儿童行为检查表评估的症状显示出可预测的关联。结论：除了一些例外，青少年的人格病理与成年人相似，并且在14-18岁的青少年中是可诊断的。为成年人制定的分类和标准可能不是诊断青少年的最佳方式。来自青少年样本的数据可能证明对发展经验和临床为基础的青少年人格病理分类是有用的。
Objective: The study of personality pathology in adolescence is in its infancy. This article examined the applicability and limits of DSM-IV axis 11 personality disorder diagnoses in adolescents, assessed the validity of a method for assessing adolescent personality pathology, and began to develop an empirically grounded classification.Method: A total of 296 randomly selected clinicians described a patient age 14-18 in treatment for maladaptive personality patterns using axis 11 ratings scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A), a Q-sort instrument for assessing adolescent personality pathology. After examining the nature and frequency of axis 11 disorders in the sample, the authors used Q-factor analysis to identify naturally occurring groupings of patients on the basis of shared personality features.Results: Axis 11 diagnoses in adolescents resembled those in adults, although application of DSM-IV criteria appeared to over-diagnose antisocial and avoidant personality disorder in adolescents. Q analysis with the SWAP-200-A isolated five personality disorders (antisocial-psychopathic, emotionally dysregulated, avoidant-constricted, narcissistic, and histrionic) and one personality style. Patients' dimensional scores on each diagnostic prototype showed predictable associations with ratings of current axis 11 disorders, measures of adaptive functioning, and symptoms assessed with the Child Behavior Checklist.Conclusions: with some exceptions, personality pathology in adolescence resembles that in adults and is diagnosable in adolescents ages 14-18. Categories and criteria developed for adults may not be the optimal way of diagnosing adolescents. Data from samples of adolescents may prove useful in developing an empirically and clinically grounded classification of personality pathology in adolescents.