Hsieh Derek K, Kirk Stuart A
University of California, Los Angeles 90095-1656, USA.
J Child Psychol Psychiatry. 2003 Sep;44(6):877-87. doi: 10.1111/1469-7610.00172.
The DSM assumes that mental disorders can be identified by the presence of specific co-occurring symptoms associated with certain duration and impaired functioning, independent of the social context in which symptoms occur. The validity of this assumption was tested using the judgments of experienced psychiatrists. We hypothesized that psychiatrists would judge an identical set of adolescent antisocial behaviors, meeting the DSM-IV diagnostic criteria for conduct disorder, as indicative of mental disorder or non-disordered problem-in-living, depending on the social context.
A representative sample of 483 psychiatrists in the United States read one of three experimentally manipulated vignettes depicting adolescent antisocial behavior and responded to questions concerning its nature, prognosis, cause, and response to various treatments.
Results supported our hypothesis. Under some circumstances, a youth may exhibit behaviors that meet the DSM-IV diagnostic criteria for conduct disorder, but be judged by psychiatrists as not having a mental disorder. In addition, as predicted, psychiatrists reached different judgments about course, etiology, and treatment responsiveness when the identical behaviors occurred in different social contexts.
The findings illuminate weaknesses in the validity of classification systems based on behavioral criteria independent of their social context. Implications of findings are discussed.
《精神疾病诊断与统计手册》（DSM）假定，精神障碍可通过存在与特定病程及功能受损相关的特定并发症状来识别，而与症状出现的社会背景无关。使用经验丰富的精神科医生的判断来检验这一假设的有效性。我们假设，精神科医生会根据社会背景，将一组符合DSM-IV品行障碍诊断标准的相同青少年反社会行为判断为精神障碍或非精神障碍的生活问题。
美国483名精神科医生的代表性样本阅读了三个经过实验操纵的描述青少年反社会行为的 vignette 之一，并回答了有关其性质、预后、原因以及对各种治疗反应的问题。
结果支持了我们的假设。在某些情况下，青少年可能表现出符合DSM-IV品行障碍诊断标准的行为，但精神科医生判断其没有精神障碍。此外，正如预测的那样，当相同行为发生在不同社会背景中时，精神科医生对病程、病因和治疗反应性得出了不同的判断。
研究结果揭示了基于独立于社会背景的行为标准的分类系统在有效性方面的弱点。讨论了研究结果的意义。
