Department of Psychiatry, University of Arizona College of Medicine.
Department of Psychology, Texas A&M University.
Personal Disord. 2013 Oct;4(4):342-9. doi: 10.1037/per0000029.
An alternative model for the diagnosis of personality disorders (PDs), based on assessments of impairments in personality functioning and of pathological personality traits, was intended for the official classification in the Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition (DSM-5), but was instead placed in Section III, "Emerging Measures and Models." This article attempts to describe forces in play during the development of DSM-5 that may have contributed to this outcome, from the perspectives of the Chair of the Personality and Personality Disorders Work Group (PPDWG) and three of its members. These include a failed imperative to shift away from the Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) categories toward a dimensional perspective on psychopathology, dynamics within the American Psychiatric Association DSM-5 Task Force and PPDWG and the roles and impact of individuals and groups in the PD community. From these considerations, we present some suggestions for how the field might move forward in the future. A new opportunity exists to use the proposed alternative model as a foundation for research. In the immediate future, with the existence of two different models of PDs in DSM-5, studies can be done comparing the models to each other and to other models with respect to reliability and antecedent, concurrent, and predictive validity. If the Section III model continues to perform as early studies suggest, it may migrate into Section II of a planned DSM-5.1. This valuable research, already underway, will shape future editions of the DSM, by providing data to articulate a clearer vision, with broader representation of reliable and valid models. Going forward, personal investments must be put aside for the benefit of the greater good.
一种基于人格功能障碍和病态人格特征评估的人格障碍（PD）诊断替代模型，旨在纳入《精神障碍诊断与统计手册第五版》（DSM-5）的正式分类，但最终被置于第三部分“新兴措施和模型”。本文试图从人格和人格障碍工作组（PPDWG）主席以及其三名成员的角度描述在 DSM-5 制定过程中可能促成这一结果的各种因素。这些因素包括从《精神障碍诊断与统计手册第四版》（DSM-IV）类别向精神病理学的维度视角转变的失败指令、美国精神病学协会 DSM-5 工作组和 PPDWG 内部的动态以及个人和团体在 PD 领域中的角色和影响。从这些考虑出发，我们提出了一些关于该领域未来如何发展的建议。目前有一个新的机会可以利用拟议的替代模型作为研究的基础。在不久的将来，由于 DSM-5 中存在两种不同的 PD 模型，可以进行研究，比较这些模型彼此之间以及与其他模型的可靠性以及先验、同期和预测有效性。如果第三部分模型继续按照早期研究的建议表现，它可能会迁移到计划中的 DSM-5.1 的第二部分。这项有价值的研究已经在进行中，将通过提供数据来阐明一个更清晰的愿景，更广泛地代表可靠和有效的模型，从而影响未来的 DSM 版本。展望未来，必须为了更大的利益而搁置个人利益。
