Department of Psychology, Northeastern University, Boston, MA 02115-5000, USA.
Psychol Assess. 2012 Sep;24(3):581-91. doi: 10.1037/a0026416. Epub 2011 Dec 5.
Psychological abnormality is a fundamental concept in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) and in all clinical evaluations. How do practicing clinical psychologists use the context of life events to judge the abnormality of a person's current behaviors? The appropriate role of life-event context in assessment has long been the subject of intense debate and scrutiny among clinical theorists, yet relatively little is known about clinicians' own judgments in practice. The authors propose a proportionate-response hypothesis, such that judgments of abnormality are influenced by whether the behaviors are a disproportionate response to past events, rendering them difficult to understand or explain. Licensed, practicing clinical psychologists (N = 77) were presented with vignettes describing hypothetical people's behaviors (disordered, mildly distressed, or unaffected) that had been preceded by either traumatic or mildly distressing events. Experts' judgments of abnormality were strongly and systematically influenced by the degree of mismatch between the past event and current behaviors in strength and valence, such that the greater the mismatch, the more abnormal the person seemed. A separate, additional group of clinical psychologists (N = 20) further confirmed that the greater the degree of mismatch, the greater the perceived difficulty in understanding the patient. These findings held true across clinicians of different theoretical orientations and in disorders for which these patterns of judgments ran contrary to formal recommendations in the DSM-IV-TR (American Psychiatric Association, 2000). The rationality of these effects and implications for clinical decision science are discussed.
心理异常是《精神障碍诊断与统计手册》（DSM-IV-TR；美国精神病学协会，2000 年）和所有临床评估中的一个基本概念。执业临床心理学家如何利用生活事件的背景来判断一个人当前行为的异常？生活事件背景在评估中的适当作用一直是临床理论家激烈辩论和审查的主题，但关于临床医生在实践中的自身判断相对知之甚少。作者提出了一个相称反应假说，即异常判断受到行为是否对过去事件做出不成比例的反应的影响，从而使这些行为难以理解或解释。有执照的执业临床心理学家（N=77）阅读了描述假设人物行为（异常、轻度困扰或未受影响）的情景，这些行为之前发生了创伤性或轻度困扰事件。专家对异常的判断受到过去事件与当前行为在强度和性质上的不匹配程度的强烈和系统影响，即不匹配程度越大，人似乎越异常。一个单独的、额外的临床心理学家小组（N=20）进一步证实，不匹配程度越大，对患者的理解就越困难。这些发现适用于不同理论取向的临床医生，也适用于这些判断模式与 DSM-IV-TR（美国精神病学协会，2000 年）中的正式建议相悖的障碍。讨论了这些影响的合理性及其对临床决策科学的意义。
