Spitzer M
Department of Psychology, Harvard University, Cambridge, MA 02138.
Compr Psychiatry. 1990 Sep-Oct;31(5):377-97. doi: 10.1016/0010-440x(90)90023-l.
The DSM-III-R definition of delusions bears inconsistencies and does not account for the way delusions are detected clinically. It can be traced back to Karl Jaspers who was the first to mention the three criteria of delusions, which are to be found in the textbooks ever since: (1) certainty, (2) incorrigibility, and (3) impossibility or falsity of content. Psychiatrists always felt uncomfortable with the third criterion, and Kurt Schneider pursued the most thorough attempt to dispose of this criterion by his definition of delusional perception. It can be shown that while his definition is wrong, the phenomena he had in mind do, in fact, have some distinctive features. Proceeding from the first two criteria of Jaspers, a new definition is proposed that emphasizes the way certain contents are stated and disregards the issue of right or wrong. Advantages of this definition are discussed and a distinction between delusions (about external reality) and certain actual experiences (happening in the patient's mind) is proposed.
《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中对妄想的定义存在不一致之处，且未考虑临床中检测妄想的方式。它可以追溯到卡尔·雅斯贝尔斯，他是第一个提及妄想的三个标准的人，从那以后这三个标准就一直出现在教科书中：（1）确定性，（2）不可纠正性，以及（3）内容的不可能性或虚假性。精神科医生一直对第三个标准感到不满，库尔特·施耐德通过他对妄想性感知的定义，进行了最彻底的尝试来摒弃这个标准。可以证明，虽然他的定义是错误的，但他所考虑的现象实际上确实有一些独特的特征。从雅斯贝尔斯的前两个标准出发，提出了一个新的定义，该定义强调某些内容的陈述方式，而忽略对错问题。讨论了这个定义的优点，并提出了妄想（关于外部现实）与某些实际体验（发生在患者脑海中）之间的区别。
