Zimmerman Mark, Galione Janine N, Chelminski Iwona, Young Diane, Dalrymple Kristy, Morgan Theresa A
Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.
Ann Clin Psychiatry. 2012 Aug;24(3):195-201.
A stated goal of the DSM-5 Work Group on Personality and Personality Disorders (PDs) has been to reduce the high rate of comorbidity among PDs. Few studies have examined whether the diagnosis of multiple PDs has clinical significance. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we tested the hypothesis that patients with >1 DSM-IV PD would have more severe forms of psychopathology than patients who were diagnosed with only 1 DSM-IV PD.
A total of 2,150 psychiatric outpatients were evaluated with semi-structured diagnostic interviews for DSM-IV Axis I and Axis II disorders and measures of psychosocial morbidity.
For 8 of the 10 PDs, the majority of patients had at least 1 additional PD, although at least 20% of patients diagnosed with each PD were diagnosed with only 1 PD. Compared with patients with 1 PD, patients with ≥2 PDs had significantly more psychosocial morbidity.
The co-occurrence of PDs conveys clinically significant information. Moreover, despite high levels of comorbidity, each PD also existed as a stand-alone entity. These findings raise questions about the DSM-5 Work Group's emphasis on reducing comorbidity in Axis II.
《精神疾病诊断与统计手册》第五版（DSM - 5）人格与人格障碍工作组的既定目标之一是降低人格障碍（PDs）之间的高共病率。很少有研究探讨多重人格障碍的诊断是否具有临床意义。在罗德岛改善诊断评估与服务方法项目的本报告中，我们检验了这样一个假设，即患有超过1种DSM - IV人格障碍的患者比仅被诊断患有1种DSM - IV人格障碍的患者具有更严重形式的精神病理学表现。
对总共2150名精神科门诊患者进行了针对DSM - IV轴I和轴II障碍的半结构化诊断访谈以及心理社会发病率测量。
在10种人格障碍中的8种中，大多数患者至少还有1种其他人格障碍，尽管每种人格障碍的诊断患者中至少有20%仅被诊断出患有1种人格障碍。与患有1种人格障碍的患者相比，患有≥2种人格障碍的患者具有显著更多的心理社会发病率。
人格障碍的共病传递了具有临床意义的信息。此外，尽管共病水平很高，但每种人格障碍也作为一个独立实体存在。这些发现对DSM - 5工作组强调降低轴II中的共病率提出了疑问。
