Lefere Sander, De Rouck Ruben, De Vreese Leen
Ghent University Hospital, Ghent, Belgium.
Division University Hospital Brussels, Jette, Belgium.
J Eval Clin Pract. 2017 Oct;23(5):981-987. doi: 10.1111/jep.12686. Epub 2016 Dec 28.
The reliability and validity of psychiatric diagnoses have always been a major concern. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) reliability field trials yielded ambiguous results, with some diagnostic categories scoring well below par. We argue that the emphasis on the reliability of psychiatric diagnoses, which has dominated psychiatric nosology and guided the endeavor of improving the DSM in its consecutive editions, is misguided and lacks in structural validity. In this article, we defend a pragmatic view on psychiatric disease as the most fruitful approach to an understanding of what the categorical distinctions in the DSM (can) represent. Disorders in the DSM are descriptions of clinical pictures and do not necessarily correspond to an identified pathological substrate. Although this is a logical result of the nature of psychiatric disease, it bears important consequences. The various DSM disease categories are not uniform but should be regarded as representing different kinds of disorders, ranging from a separation from normal behavior based on practical grounds to the discrete kind of disorders envisioned by proponents of a strong realistic view. We argue that the explication of kinds of disorders outlined in this article provides interesting perspectives on the problems of reliability and validity that the DSM faces.
精神疾病诊断的可靠性和有效性一直是一个主要关注点。《精神疾病诊断与统计手册》第五版（DSM - 5）的可靠性现场试验得出了模糊的结果，一些诊断类别得分远低于标准。我们认为，对精神疾病诊断可靠性的强调主导了精神疾病分类学，并在其连续版本中指导了改进DSM的努力，这种强调是错误的，并且缺乏结构效度。在本文中，我们捍卫一种关于精神疾病的实用主义观点，认为这是理解DSM中分类区别（能够）代表什么的最富有成效的方法。DSM中的疾病是临床症状的描述，不一定对应于已确定的病理基础。虽然这是精神疾病本质的逻辑结果，但它具有重要影响。DSM中的各种疾病类别并不统一，而应被视为代表不同类型的疾病，从基于实际理由与正常行为的分离到强烈现实主义观点支持者所设想的离散型疾病。我们认为，本文中对疾病类型的阐述为DSM所面临的可靠性和有效性问题提供了有趣的视角。
