Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
J Pers Assess. 2011 Jul;93(4):362-9. doi: 10.1080/00223891.2011.577474.
This article outlines a model of personality disorder (PD) diagnosis that combines clinically useful constructs from the Diagnostic and Statistical Manual of Mental Disorders (DSM) with assessment procedures that maximize reliability and clinical utility while minimizing problems associated with threshold-based PD classification. I begin by addressing limitations in the current DSM conceptualization of PDs: excessive comorbidity, use of arbitrary cutoffs to distinguish normal from pathological functioning, failure to capture variations in the adaptive value of PD symptoms, and inattention to situational influences that shape PD-related behaviors. The revisions proposed by the DSM-5 Personality and Personality Disorders Work Group help resolve some of these issues, but create new problems in other areas. A better solution would be to employ a multidimensional model of PD diagnosis in which clinicians (a) assign a single dimensional rating of overall level of personality dysfunction, (b) provide separate intensity and impairment ratings for each PD dimension, and (c) list those personality traits-including PD-related traits-that enhance adaptation and functioning. Preliminary evidence bearing on the multidimensional model is reviewed, and broader clinical and empirical implications of the model are discussed.
本文概述了一种人格障碍（PD）诊断模型，该模型结合了《精神障碍诊断与统计手册》（DSM）中临床有用的概念，并采用了最大限度地提高可靠性和临床实用性的评估程序，同时最小化与基于阈值的 PD 分类相关的问题。我首先讨论了当前 DSM 对 PD 的概念化的局限性：过度共病、使用任意截止值来区分正常和病理功能、未能捕捉 PD 症状适应价值的变化，以及对塑造 PD 相关行为的情境影响的关注不足。DSM-5 人格和人格障碍工作组提出的修订有助于解决其中的一些问题，但在其他领域又产生了新的问题。一个更好的解决方案是采用多维 PD 诊断模型，临床医生可以在该模型中(a) 对整体人格功能障碍的严重程度进行单一维度的评估，(b) 对每个 PD 维度进行单独的强度和损害评估，以及 (c) 列出那些增强适应性和功能的人格特质，包括 PD 相关特质。本文回顾了多维模型的初步证据，并讨论了该模型更广泛的临床和实证意义。
