636,120 Ways to Have Posttraumatic Stress Disorder
636,120 Ways to Have Posttraumatic Stress Disorder
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DOI：
10.1177/1745691613504115
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发表时间：
2013-11-01
影响因子：
12.6
通讯作者：
Bryant, Richard A.
中科院分区：
文献类型：
--
作者：
Galatzer-Levy, Isaac R.;Bryant, Richard A.
为了捕捉创伤应激后出现的各种症状，第5版《精神疾病诊断和统计手册》(DSM-5)对创伤后应激障碍(PTSD)标准的修订已扩大到包括更多的症状表现。这种扩展的一个后果是，它增加了分类的无定形性质。使用二项式方程来阐明可能的症状组合，我们证明列出的创伤后应激障碍的DSM-IV标准具有高度的症状谱异质性(79,794个组合)；这些变化导致DSM-5的八倍扩展，达到636,120个组合。在这篇文章中，我们以创伤后应激障碍为例，通过阐明固有缺陷来讨论基于DSM的诊断实体在研究中用于分类的局限性，这些固有缺陷要么是DSM历史上的特定人工产物，要么是DSM分类方法的潜在逻辑的内在缺陷。我们讨论了新的研究方向，可以提供关于临床和非临床行为异质性的更好信息，以应对潜在的创伤和常见的应激生活事件。这些先验分类系统的经验替代方案有望回答为什么应激源会出现多样性的问题。
In an attempt to capture the variety of symptoms that emerge following traumatic stress, the revision of posttraumatic stress disorder (PTSD) criteria in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has expanded to include additional symptom presentations. One consequence of this expansion is that it increases the amorphous nature of the classification. Using a binomial equation to elucidate possible symptom combinations, we demonstrate that the DSM-IV criteria listed for PTSD have a high level of symptom profile heterogeneity (79,794 combinations); the changes result in an eightfold expansion in the DSM-5, to 636,120 combinations. In this article, we use the example of PTSD to discuss the limitations of DSM-based diagnostic entities for classification in research by elucidating inherent flaws that are either specific artifacts from the history of the DSM or intrinsic to the underlying logic of the DSM's method of classification. We discuss new directions in research that can provide better information regarding both clinical and nonclinical behavioral heterogeneity in response to potentially traumatic and common stressful life events. These empirical alternatives to an a priori classification system hold promise for answering questions about why diversity occurs in response to stressors.