Terluin Berend, Oud Marian J T
VU medisch centrum, EMGO-instituut, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(51):A5684.
The DSM diagnosis of depression is based solely on the presence of symptoms, without taking into account the context in which these symptoms have occurred. For this reason, the DSM diagnosis does not distinguish between sadness as a normal reaction to a painful loss and pathologically depressive reactions that are disproportionate to personal life events and circumstances. According to a group of mental health expert general practitioners, a true depressive disorder is characterized by a depression that has acquired a life of its own and is hard to control. This depression is severe, and is recognized by the patient as alien to his or her character. Loss of the ability to experience pleasure in ordinary things (anhedonia) and thoughts about death as an alternative for the torment experienced are often present. We recommend the diagnosis of depression be reserved for clearly pathologically depressive reactions that are also recognized as such by the patient.
《精神疾病诊断与统计手册》(DSM)对抑郁症的诊断仅基于症状的存在,而不考虑这些症状出现的背景。因此,DSM诊断无法区分作为对痛苦丧失的正常反应的悲伤与与个人生活事件和情况不成比例的病理性抑郁反应。根据一群心理健康专家全科医生的说法,真正的抑郁症的特征是抑郁症已经有了自己的“生命”且难以控制。这种抑郁症很严重,患者认为它与自己的性格不符。通常还会出现无法从平常事物中体验到乐趣(快感缺失)以及将死亡视为摆脱所经历折磨的一种选择的想法。我们建议将抑郁症的诊断保留给明显的病理性抑郁反应,且患者也认可这是病理性的。