Curr Med Res Opin. 2012 Mar;28(3):335-43. doi: 10.1185/03007995.2011.653436. Epub 2012 Feb 22.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is currently undergoing a revision that will lead to a fifth edition in 2013. Proposed changes for DSM-5 include the creation of several new categories of depressive disorder. Some nosologists have expressed concern that the proposed changes could yield many 'false-positive diagnoses' in which normal distress is mislabeled as a mental disorder. Such confusion of normal distress and mental disorder undermines the interpretability of clinical trials and etiological research, causes inefficient allocation of resources, and incurs risks of unnecessary treatment. To evaluate these concerns, I critically examine five proposed DSM-5 expansions in the scope of depressive and grief disorders: (1) a new mixed anxiety/depression category; (2) a new premenstrual dysphoric disorder category; (3) elimination of the major depression bereavement exclusion; (4) elimination of the adjustment disorder bereavement exclusion, thus allowing the diagnosis of subsyndromal depressive symptoms during bereavement as adjustment disorders; and (5) a new category of adjustment disorder related to bereavement for diagnosing pathological non-depressive grief. I examine each proposal's face validity and conceptual coherence as well as empirical support where relevant, with special attention to potential implications for false-positive diagnoses. I conclude that mixed anxiety/depression and premenstrual dysphoric disorder are needed categories, but are too broadly drawn and will yield substantial false positives; that the elimination of the bereavement exclusion is not supported by the evidence; and that the proposed elimination of the adjustment-disorder bereavement exclusion, as well as the new category of grief-related adjustment disorder, are inconsistent with recent grief research, which suggests that these proposals would massively pathologize normal grief responses.
《精神障碍诊断与统计手册》(DSM)目前正在修订,预计 2013 年将推出第五版。DSM-5 的修订建议包括创建几种新的抑郁障碍类别。一些分类学家担心,这些修订建议可能会导致许多“假阳性诊断”,即将正常的痛苦误诊为精神障碍。这种将正常痛苦与精神障碍混淆的做法,破坏了临床试验和病因研究的可解释性,导致资源分配效率低下,并带来不必要治疗的风险。为了评估这些担忧,我对抑郁和悲伤障碍领域的 DSM-5 五个扩展提案进行了批判性审查:(1)新的混合焦虑/抑郁类别;(2)新的经前烦躁障碍类别;(3)消除重大抑郁丧亲排除;(4)消除适应障碍丧亲排除,从而允许在丧亲期间将亚综合征抑郁症状诊断为适应障碍;(5)一个与丧亲相关的适应障碍类别,用于诊断病理性非抑郁性悲伤。我审查了每个提案的表面有效性和概念一致性,以及相关的实证支持,特别关注潜在的假阳性诊断影响。我得出的结论是,混合焦虑/抑郁和经前烦躁障碍是必要的类别,但范围太广,会产生大量的假阳性;丧亲排除的消除没有得到证据的支持;以及提议消除适应障碍丧亲排除,以及与悲伤相关的适应障碍新类别,与最近的悲伤研究不一致,这表明这些提案将大规模将正常悲伤反应病理化。