Luciano Mario, Sampogna Gaia, Del Vecchio Valeria, De Rosa Corrado, Albert Umberto, Carrà Giuseppe, Dell'Osso Bernardo, Lorenzo Giorgio Di, Ferrari Silvia, Martinotti Giovanni, Nanni Maria Giulia, Pinna Federica, Pompili Maurizio, Volpe Umberto, Catapano Francesco, Fiorillo Andrea
Dipartimento di Psichiatria, Università di Napoli SUN.
Dipartimento di Neuroscienze Rita Levi Montalcini, Università di Torino; Azienda Ospedaliero-Universitaria San Luigi Gonzaga di Orbassano, Torino.
Riv Psichiatr. 2016 May-Jun;51(3):116-21. doi: 10.1708/2304.24798.
Since its first edition, the Diagnostic and Statistical manual of Mental disorders (DSM) has had a great impact on the scientific community and the public opinion as well. In 2013, the American Psychiatric Association released the fifth edition of the manual and - as for the previous versions - several criticisms raised. In particular, the persistence of the categorical approach to mental disorders represents one of the main debated topics, as well as the introduction of new diagnostic syndromes, which are not based on an adequate evidences. Moreover, the threshold of diagnostic criteria for many mental disorders has been lowered, with the consequence that the boundaries between "normality" and "pathology" is not so clear. In this paper, we will: 1) report the historical development of the DSM from the publication of its first edition; 2) describe the main changes introduced in the DSM-5; 3) discuss critical elements in the DSM-5. The current debate regarding the validity of diagnostic manuals and its criteria is threatening the psychiatric discipline, but a possible solution should be represented by the integration of diagnostic criteria with the in-depth description of patient's psychopathological experiences.
自第一版问世以来，《精神疾病诊断与统计手册》（DSM）对科学界和公众舆论都产生了巨大影响。2013年，美国精神病学协会发布了该手册的第五版，与之前的版本一样，引发了一些批评。特别是，对精神障碍采用分类方法的持续存在是主要争议话题之一，新诊断综合征的引入也是如此，而这些综合征并非基于充分的证据。此外，许多精神障碍的诊断标准门槛降低了，结果“正常”与“病理”之间的界限变得不那么清晰。在本文中，我们将：1）报告自DSM第一版出版以来的历史发展；2）描述DSM-5中引入的主要变化；3）讨论DSM-5中的关键要素。当前关于诊断手册及其标准有效性的争论正威胁着精神病学学科，但一个可能的解决方案应该是将诊断标准与对患者心理病理体验的深入描述相结合。
