Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
Can J Psychiatry. 2010 Nov;55(11):692-700. doi: 10.1177/070674371005501102.
Work is currently under way on the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, due to be published by the American Psychiatric Association in 2013. Dissatisfaction with the current categorical descriptive approach has led to aspirations for a paradigm shift for DSM-5.
A historical review of past revisions of the DSM was performed. Efforts undertaken before the start of the DSM-5 development process to conduct a state-of-the science review and set a research agenda were examined to determine if results supported a paradigm shift for DSM-5. Proposals to supplement DSM-5 categorical diagnosis with dimensional assessments are reviewed and critiqued.
DSM revisions have alternated between paradigm shifts (the first edition of the DSM in 1952 and DSM-III in 1980) and incremental improvements (DSM-II in 1968, DSM-III-R in 1987, and DSM-IV in 1994). The results of the review of the DSM-5 research planning initiatives suggest that despite the scientific advances that have occurred since the descriptive approach was first introduced in 1980, the field lacks a sufficiently deep understanding of mental disorders to justify abandoning the descriptive approach in favour of a more etiologically based alternative. Proposals to add severity and cross-cutting dimensions throughout DSM-5 are neither paradigm shifting, given that simpler versions of such dimensions are already a component of DSM-IV, nor likely to be used by busy clinicians without evidence that they improve clinical outcomes.
Despite initial aspirations that DSM would undergo a paradigm shift with this revision, DSM-5 will continue to adopt a descriptive categorical approach, albeit with a greatly expanded dimensional component.
目前正在修订《精神障碍诊断与统计手册》（DSM）第五版，预计由美国精神病学协会于 2013 年出版。由于对当前的分类描述方法不满意，因此人们希望在 DSM-5 中实现范式转变。
对 DSM 过去的修订版本进行了历史回顾。检查了在 DSM-5 开发过程开始之前为进行科学现状审查和制定研究议程而进行的努力，以确定是否有结果支持 DSM-5 的范式转变。审查和批评了用维度评估补充 DSM-5 分类诊断的建议。
DSM 的修订交替进行范式转变（1952 年的第一版 DSM 和 1980 年的 DSM-III）和增量改进（1968 年的 DSM-II、1987 年的 DSM-III-R 和 1994 年的 DSM-IV）。对 DSM-5 研究规划计划的审查结果表明，尽管自 1980 年首次引入描述性方法以来已经取得了科学进步，但该领域对精神障碍的理解还不够深入，无法证明放弃描述性方法转而采用更具病因学基础的替代方法是合理的。在 DSM-5 中添加严重程度和跨领域维度的建议既不是范式转变，因为此类维度的更简单版本已经是 DSM-IV 的一部分，也不太可能被忙碌的临床医生使用，除非有证据表明它们可以改善临床结果。
尽管最初希望 DSM 在此次修订中实现范式转变，但 DSM-5 将继续采用描述性分类方法，尽管其维度组成部分大大扩展。
