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诊断标准中的规范性依据:以《精神疾病诊断与统计手册》第四版修订版中的人格障碍为例。

Normative warrant in diagnostic criteria: the case of DSM-IV-TR personality disorders.

作者信息

Sadler John Z, Fulford Bill

机构信息

Department of Psychiatry, UT Southwestern, Dallas, TX 75390-9070, USA.

出版信息

J Pers Disord. 2006 Apr;20(2):170-80; discussion 181-5. doi: 10.1521/pedi.2006.20.2.170.

Abstract

This article focuses on the kinds of evaluative judgments made when applying DSM-IV-TR diagnostic criteria within the diagnostic interview between clinician and patient. The authors name these kinds of value judgments in diagnosis "normative warrant" because they involve one or more justifications (warrants) for standard-bearing (normative) elements involved in applying diagnostic criteria to actual patients. Seven types of normative warrant judgments are described (Type 1, Semantic-Phenomenal Matching; Type 2, Solicitation Choice; Type 3, Sociocultural Context; Type 4, Performance-Context Matching; Type 5, Deviance Threshold; Type 6, Threshold Characterization; Type 7, Disvalue characterization) and the typology is illustrated by applying it to various DSM-IV-TR personality disorder criteria. A research and clinical understanding of normative warrant may well contribute to the refinement of criteria sets as well as the refinement of the clinical use of criteria sets.

摘要

本文聚焦于临床医生与患者进行诊断访谈时,应用《精神疾病诊断与统计手册》第四版修订版(DSM-IV-TR)诊断标准过程中所做出的各类评估判断。作者将诊断过程中的这类价值判断命名为“规范性依据”,因为它们涉及将诊断标准应用于实际患者时,对标准性(规范性)要素的一个或多个正当理由(依据)。文中描述了七种规范性依据判断类型(类型1,语义-现象匹配;类型2,征求性选择;类型3,社会文化背景;类型4,表现-背景匹配;类型5,偏差阈值;类型6,阈值特征描述;类型7,负价值特征描述),并通过将其应用于各种DSM-IV-TR人格障碍标准来说明该类型学。对规范性依据的研究和临床理解很可能有助于完善标准集以及优化标准集的临床应用。

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