The Research Department, Clinic of Mental Health, Aker University Hospital, 0320 Oslo, Norway.
Compr Psychiatry. 2009 Nov-Dec;50(6):533-41. doi: 10.1016/j.comppsych.2009.01.003. Epub 2009 Mar 12.
This article examines reliability and validity aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) paranoid personality disorder (PPD) diagnosis.
Patients with personality disorders (n = 930) from the Norwegian network of psychotherapeutic day hospitals, of which 114 had PPD, were included in the study. Frequency distribution, chi(2), correlations, reliability statistics, exploratory, and confirmatory factor analyses were performed.
The distribution of PPD criteria revealed no distinct boundary between patients with and without PPD. Diagnostic category membership was obtained in 37 of 64 theoretically possible ways. The PPD criteria formed a separate factor in a principal component analysis, whereas a confirmatory factor analysis indicated that the DSM-IV PPD construct consists of 2 separate dimensions as follows: suspiciousness and hostility. The reliability of the unitary PPD scale was only 0.70, probably partly due to the apparent 2-dimensionality of the construct. Persistent unwarranted doubts about the loyalty of friends had the highest diagnostic efficiency, whereas unwarranted accusations of infidelity of partner had particularly poor indicator properties.
The reliability and validity of the unitary PPD construct may be questioned. The 2-dimensional PPD model should be further explored.
本文探讨了《精神障碍诊断与统计手册》第四版（DSM-IV）偏执型人格障碍（PPD）诊断的可靠性和有效性方面。
该研究纳入了来自挪威心理治疗日间医院网络的人格障碍患者（n=930），其中 114 名患者患有 PPD。进行了频率分布、卡方检验、相关性分析、可靠性统计、探索性和验证性因子分析。
PPD 标准的分布显示，有和没有 PPD 的患者之间没有明显的界限。在 64 种理论上可能的诊断类别中，有 37 种可以明确归属。在主成分分析中，PPD 标准形成了一个单独的因子，而验证性因子分析表明，DSM-IV PPD 结构由以下两个独立维度组成：多疑和敌意。单一 PPD 量表的可靠性仅为 0.70，这可能部分归因于该结构的明显二维性。对朋友忠诚度的无端持续怀疑具有最高的诊断效率，而对伴侣不忠的无端指责则具有较差的指标特性。
单一 PPD 结构的可靠性和有效性可能受到质疑。二维 PPD 模型应进一步探索。
