Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Psychology Assessment Center, Boston, MA 02114, USA.
Compr Psychiatry. 2013 May;54(4):326-33. doi: 10.1016/j.comppsych.2012.10.014. Epub 2012 Dec 5.
The revisions proposed for the DSM-5 would greatly alter how personality pathology is conceptualized, assessed, and diagnosed. One aspect of the proposed changes, elimination of four current personality disorders, has raised considerable controversy. The present study attempts to inform this debate by exploring clinicians' views of the structure of Personality Disorders using the current diagnostic system, the DSM-IV. An exploratory factor analysis was conducted on the DSM-IV Personality Disorder criteria using clinician ratings for 280 patients. The factor analysis revealed eight clear and meaningful factors. The eight factors contained all six personality disorders proposed for retention in DSM-5 but also contained clear representations of two disorders (Paranoid and Schizoid) identified for removal from the system. These conditions appear to have clinical utility and their removal may have unintended negative consequences in clinical practice. Dependent and Avoidant criteria also merged to form a new construct with interesting clinical implications. These findings provide new insights into the complex typologies clinicians employ when applying the DSM-IV system to personality disordered patients. Lastly we argue that successful refinement of clinically significant constructs, like diagnostic systems, requires a balanced appraisal of evidence for clinical utility as well as external and internal validity.
DSM-5 的修订将极大地改变人格病理学的概念化、评估和诊断方式。拟议变更的一个方面，即消除四种当前的人格障碍，引起了相当大的争议。本研究试图通过使用当前的诊断系统 DSM-IV 来探索临床医生对人格障碍结构的看法来为这场辩论提供信息。对 280 名患者的 DSM-IV 人格障碍标准进行了探索性因素分析。因素分析揭示了八个清晰而有意义的因素。这八个因素包含了保留在 DSM-5 中的所有六种人格障碍，但也清楚地代表了两个被认为应从系统中删除的障碍（偏执型和分裂样型）。这些病症似乎具有临床实用性，如果将其删除，可能会对临床实践产生意想不到的负面影响。依赖型和回避型标准也合并形成了一个具有有趣临床意义的新结构。这些发现为临床医生在将 DSM-IV 系统应用于人格障碍患者时所采用的复杂分类学提供了新的见解。最后，我们认为，要成功改进具有临床意义的结构，例如诊断系统，就需要对临床实用性以及外部和内部有效性的证据进行平衡评估。
