Comparing Alternative Dimensional Approaches to Personality Diagnosis

描述（由申请人提供）：尽管人格障碍（PD）和阈下人格病理学越来越多地被认为是许多轴I障碍的素质和治疗反应的调节剂，但研究人员已经确定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DSM-V显然将转向PD的维度诊断。然而，还没有研究检查的主要尺寸替代品的比较有效性。其次，几乎所有的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，完全依赖自我报告的局限性。本建议的主要目的是评估分类PD诊断和四维替代诊断的比较有效性：DSM-IV诊断（每种疾病的症状数量）;最近开发的共识四因素特质模型从自我报告数据中通过因素分析确定;经验得出的维度PD综合征;和PD性状使用主要不依赖于自我报告的方法通过因子分析得出。考虑到DSM-V中可能保留当前PD的维度化版本，次要目的是比较使用当前PD从维度诊断患者的方法，这些方法依赖于自我报告。S将是三个研究中心的240例患者。对于这两个目标，我们将使用以下标准变量来评估有效性：（a）汇总的非专业知情人报告PD和特质数据;（B）治疗-临床医生PD和特质数据;（c）同时和纵向评估的适应功能（18个月随访）;（d）病因学数据，包括发育史（儿童期创伤）、精神疾病家族史和分子遗传学;以及（e）旨在评估特定PD的实验室（隐性）措施。我们的总体目标是使用两套标准来评估有效性，这两套标准在今天很大程度上被视为一种单一的方法：罗宾斯和古泽标准（即，诊断是否在病因、预后、实验室检查等方面不同）以及构造验证（即，诊断是否以可预测的方式在其外部相关性方面不同）。

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).