Westen Drew, Defife Jared A, Bradley Bekh, Hilsenroth Mark J
Departments of Psychology and Psychiatry and Behavioral Sciences, Emory University.
Prof Psychol Res Pr. 2010 Dec;41(6):482-487. doi: 10.1037/a0021555.
Several studies suggest that a prototype matching approach yields diagnoses of comparable validity to the more complex diagnostic algorithms outlined in DSM-IV. Furthermore, clinicians prefer prototype diagnosis of personality disorders (PDs) to the current categorical diagnostic system or alternative dimensional methods. An important extension of this work is to investigate the degree to which clinicians are able to make prototype diagnoses reliably. The aim of this study is to assess the inter-rater reliability of a prototype matching approach to personality diagnosis in clinical practice. Using prototypes derived empirically in prior research, outpatient clinicians diagnosed patients' personality after an initial evaluation period. External evaluators independently diagnosed the same patients after watching videotapes of the same clinical hours. Inter-rater reliability for prototype diagnosis was high, with a median r = .72. Cross-correlations between disorders were low, with a median r = .01. Clinicians and clinically trained independent observers can assess complex personality constellations with high reliability using a simple prototype matching procedure, even with prototypes that are relatively unfamiliar to them. In light of its demonstrated reliability, efficiency, and versatility, prototype diagnosis appears to be a viable system for DSM-V and ICD-11 with exceptional utility for research and clinical practice.
多项研究表明，原型匹配法得出的诊断结果与《精神疾病诊断与统计手册》第四版（DSM-IV）中概述的更复杂的诊断算法具有相当的效度。此外，与当前的分类诊断系统或替代的维度方法相比，临床医生更喜欢人格障碍（PDs）的原型诊断。这项工作的一个重要扩展是调查临床医生能够可靠地进行原型诊断的程度。本研究的目的是评估临床实践中人格诊断的原型匹配法的评分者间信度。使用先前研究中凭经验得出的原型，门诊临床医生在初始评估期后对患者的人格进行诊断。外部评估者在观看相同临床时段的录像带后，独立对相同患者进行诊断。原型诊断的评分者间信度很高，中位数r = 0.72。各障碍之间的交叉相关性很低，中位数r = 0.01。临床医生和经过临床培训的独立观察者可以使用简单的原型匹配程序，以高信度评估复杂的人格特征，即使是使用他们相对不熟悉的原型。鉴于其已证明的信度、效率和通用性，原型诊断似乎是《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）的一个可行系统，对研究和临床实践具有特殊用途。
