Comparing Alternative Dimensional Approaches to Personality Diagnosis

描述（由申请人提供）：尽管人格障碍（pd）和阈下人格病理越来越多地被认为是许多I轴障碍的特质和治疗反应的调节因子，但研究人员已经发现了一些限制其效用的问题，其中两个问题特别重要。首先，人格诊断的维度方法始终优于分类诊断，而且很明显，DSM-V将转向人格障碍的维度诊断。然而，目前还没有研究检验主要维度替代方案的相对有效性。其次，几乎所有PD研究都依赖于患者的自我报告；然而，越来越多的证据表明，完全依赖自我报告是有局限性的。本建议的主要目的是评估PD分类诊断和四维替代诊断的相对有效性：维度DSM-IV诊断（每种疾病符合的症状数量）；最近建立的共识四因素特质模型从自我报告数据中识别因素；经验性多维PD综合征；和PD特征的因素分析，使用的方法不主要依赖于自我报告。第二个目的，考虑到当前pd的维度版本在DSM-V中可能保留，是比较使用当前pd的维度诊断方法，这些方法对自我报告的依赖程度不同。将有240名患者在三个地点接受治疗。为了这两个目的，我们将使用以下标准变量来评估有效性：(a)汇总的外行人举报人报告的PD和特征数据；(b)治疗-临床PD和特征数据；(c)同时和纵向评估适应功能（18个月随访）；(d)病因学资料，包括发展史（儿童创伤）、精神疾病家族史和分子遗传学；(e)实验室（隐性）措施，以评估特定的有害物质。我们的总体目标是使用两套标准来评估有效性，这两套标准今天在很大程度上被视为一种单一的方法：罗宾斯和古兹标准（即，诊断是否在病因、预后、实验室测试等方面存在差异）和结构验证（即，诊断是否在可预测的方式上存在外部相关性差异）。

DESCRIPTION (provided by applicant): Although personality disorders (PDs) and subthreshold personality pathology are increasingly implicated as diatheses and moderators of treatment response for many Axis I disorders, researchers have identified a number of problems that limit their utility, two of which are particularly significant. First, dimensional approaches to personality diagnosis consistently outperform categorical diagnosis, and it appears clear that DSM-V will move toward dimensional diagnosis of PDs. However, no study has yet examined the comparative validity of the major dimensional alternatives. Second, virtually all PD research relies on patient self-reports; however, increasing evidence suggests limitations in the exclusive reliance on self-reports. The primary aim of this proposal is to evaluate the comparative validity of categorical PD diagnosis and four dimensional alternatives: dimensionalized DSM-IV diagnosis (number of symptoms met per disorder); the recently developed consensus four-factor trait model identified factor-analytically from self-report data; dimensional PD syndromes derived empirically; and PD traits derived factor-analytically using a method that does not rely primarily on self-reports. The secondary aim, given the potential retention in DSM-V of a dimensionalized version of the current PDs, is to compare methods of diagnosing patients dimensionally using the current PDs that vary in their reliance on self-reports. Ss will be 240 patients across three sites. For both aims, we will use the following criterion variables to assess validity: (a) aggregated lay informant-report PD and trait data; (b) treating-clinician PD and trait data; (c) adaptive functioning assessed concurrently and longitudinally (18-month follow-up); (d) etiologic data, including developmental history (childhood trauma), family history of psychiatric disorders, and molecular genetics; and (e) laboratory (implicit) measures targeted to assess specific PDs. Our general goal is to assess validity using two sets of criteria that today are largely seen as a single approach: Robins and Guze criteria (i.e., whether diagnoses differ in etiology, prognosis, laboratory tests, etc.) and construct validation (i.e., whether diagnoses differ in their external correlates in predictable ways).