Esbec Enrique, Echeburúa Enrique
Physician and Doctor in Psychology. Universidad Complutense de Madrid.
CIBERSAM. School of Psychology. Universidad del País Vasco (UPV/EHU).
Actas Esp Psiquiatr. 2015 Sep;43(5):177-86. Epub 2015 Sep 1.
A personality disorder can be considered to be a generalized pattern of behaviors, cognitions, and emotions that is enduring, begins in adolescence or early adulthood, remains stable over time, and generates stress or psychological damage. The current focus on personality disorders (PDs) is found in Section II of DSM-5 and is unchanged compared to DSMIV, except that the PDs were removed from the former Axis II of the DSM-IV and included in the central classification of disorders. However, an alternative model for further study is presented in Section III that aims to address the deficiencies in the current categorical model of PDs. The underlying idea is that PDs are an extreme version of the personality traits that everyone has. According to this approach, PDs are characterized by impaired personality functioning (areas of identity, self-direction, empathy, and intimacy) and pathological personality factors (negative affectivity, detachment, antagonism, disinhibition, and psychoticism). The diagnostic categories derived from this model include only antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal PDs. This hybrid approach to the diagnosis of PDs is complex and requires more empirical evidence before it can be incorporated into clinical practice. The proposals of the draft ICD-11 for PDs, which are based primarily on severity and dominant personality traits, are also included.
人格障碍可被视为一种普遍的行为、认知和情感模式，这种模式具有持久性，始于青春期或成年早期，随时间保持稳定，并会产生压力或心理损害。目前对人格障碍（PDs）的关注见于《精神疾病诊断与统计手册》第五版（DSM-5）的第二部分，与《精神疾病诊断与统计手册》第四版（DSM-IV）相比没有变化，只是人格障碍从DSM-IV原来的轴II中移除，并纳入了疾病的核心分类。然而，第三部分提出了一个供进一步研究的替代模型，旨在解决当前人格障碍分类模型中的缺陷。其基本观点是，人格障碍是每个人都有的人格特质的极端形式。根据这种方法，人格障碍的特征是人格功能受损（身份认同、自我导向、共情和亲密关系等方面）以及病理性人格因素（消极情感性、疏离、敌对、抑制解除和精神病性）。从这个模型得出的诊断类别仅包括反社会型、回避型、边缘型、自恋型、强迫型和分裂型人格障碍。这种人格障碍诊断的混合方法很复杂，在纳入临床实践之前需要更多的实证证据。国际疾病分类第11版（ICD-11）草案中关于人格障碍的提议也包括在内，这些提议主要基于严重程度和占主导地位的人格特质。
