Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, People's Republic of China.
Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, 200021, China.
Soc Psychiatry Psychiatr Epidemiol. 2018 Jan;53(1):99-106. doi: 10.1007/s00127-017-1444-3. Epub 2017 Sep 27.
This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs.
A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview.
685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China.
Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.
本研究旨在考察高危临床人群中诊断与统计手册第 5 版（DSM-5）人格障碍（PD）之间的重叠，并探索实施 DSM-5 PD 的过渡模式。
从上海精神卫生中心的 3075 名门诊患者中，选择了至少有一种已诊断 PD 的 982 名门诊患者作为样本人群。诊断过程包括人格诊断问卷和结构化临床访谈。
根据 DSM-5 第三部分提出的替代 DSM-5 人格障碍模型，685 名（22.3%）患者被诊断为至少有一种六种 PD（反社会、回避、边缘、自恋、强迫和分裂型）。近 20.3%的 PD 患者符合至少两种 PD 的标准（685 名 PD 患者中有 6 种）。聚类和主成分分析表明，对于中国的 PD 诊断，7 种特定 PD 类别（在 722 名 PD 患者中，重叠率为 24.1%）的过渡模型将更为合适。
在人格障碍的替代 DSM-5 模型中使用简化的 PD 类别将减少中国精神科实践中 PD 诊断的重叠，并应优先考虑 DSM-5 PD 诊断系统。
