Comparing Alternative Dimensional Approaches to Personality Diagnosis

描述(由申请人提供)：虽然人格障碍(PD)和阈值下人格病理越来越多地被认为是许多轴心I障碍的疾病和治疗反应的调节因素，但研究人员已经发现了一些限制其实用性的问题，其中两个特别重要。首先，人格诊断的维度方法始终优于分类诊断，而且DSM-V显然将走向对人格障碍的维度诊断。然而，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，完全依赖自我报告是有局限性的。这项建议的主要目的是评估分类PD诊断和四个维度替代方案的比较有效性：维度DSM-IV诊断(每个障碍满足的症状数量)；最近开发的共识四因素特质模型，从自我报告数据中以因素分析方式确定；维度PD症状根据经验得出；以及使用主要不依赖于自我报告的方法以因素分析方式得出的PD特征。考虑到当前PD的维度版本在DSM-V中的潜在保留，次要目的是比较使用当前PD在维度上诊断患者的方法，这些方法在依赖自我报告方面有所不同。SS将在三个地点接受240名患者的治疗。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)聚集的非调查者-报告PD和特征数据；(B)治疗-临床医生PD和特征数据；(C)同时和纵向评估的适应功能(18个月随访)；(D)病因数据，包括发展史(儿童创伤)、精神障碍家族史和分子遗传学；以及(E)实验室(隐含)措施，以评估特定的PD。我们的总体目标是使用两套标准来评估有效性，这两套标准目前大多被视为单一方法：Robins标准和Guze标准(即，诊断是否在病因、预后、实验室测试等方面有所不同)。并构建验证(即，诊断是否以可预测的方式在其外部相关性上有所不同)。

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).