Helzer John E, Kraemer Helena C, Krueger Robert F
Department of Psychiatry, University of Vermont, Burlington, VT 05403, USA.
Psychol Med. 2006 Dec;36(12):1671-80. doi: 10.1017/S003329170600821X. Epub 2006 Aug 15.
It is our contention that both categorical and dimensional approaches to diagnosis are important for clinical work and research alike, and that each approach has its drawbacks and advantages. As the processes toward developing DSM-V and ICD-11 progress, we suggest that another exclusively categorical revision of psychiatric taxonomies will no longer be sufficient and that adding a dimensional component is a necessary step if these taxonomies are to continue serving the future clinical and research needs of psychiatry as they have so effectively done in the past.
We begin the paper with a review of terminology related to categories and dimensions and briefly review literature on advantages and disadvantages of both approaches.
A review of relevant literature supports both the need for and feasibility of augmenting traditional categorical diagnoses with dimensional information.
We conclude with a proposal for preserving traditional categorical diagnostic definitions, but adding a dimensional component that would be reflective of and directly referable back to the categorical definitions. We also offer a specific proposal for adding a dimensional component to official taxonomies such as the DSM and the ICD in a way that fully preserves the traditional categorical approach.
我们认为,分类诊断法和维度诊断法对临床工作和研究均至关重要,且每种方法都有其优缺点。随着《精神疾病诊断与统计手册》第五版(DSM-V)和《国际疾病分类》第11版(ICD-11)编制进程的推进,我们认为仅对精神科分类法进行又一次彻底的分类修订已不再足够,若这些分类法要继续像过去那样有效地满足未来精神科临床和研究需求,增加一个维度成分是必要步骤。
本文开篇回顾了与类别和维度相关的术语,并简要综述了关于这两种方法优缺点的文献。
对相关文献的综述支持了用维度信息扩充传统分类诊断的必要性和可行性。
我们最后提议保留传统分类诊断定义,但增加一个维度成分,该成分应能反映并直接回溯到分类定义。我们还提出了一项具体提议,即以完全保留传统分类法的方式,在诸如DSM和ICD等官方分类法中增加一个维度成分。