Rosellini Anthony J, Boettcher Hannah, Brown Timothy A, Barlow David H
Center for Anxiety and Related Disorders, Boston University, Boston, MA.
Department of Health Care Policy, Harvard Medical School, Boston, MA.
J Exp Psychopathol. 2015 Feb;a2(1):110-128. doi: 10.5127/pr.036014. Epub 2015 Feb 14.
Although the emotional disorders (EDs) have achieved favorable reliability in the (DSM), accumulating evidence continues to underscore limitations in ED diagnostic validity. In particular, taxometric, comorbidity, and other descriptive psychopathology studies of transdiagnostic phenotypes studies suggest that the EDs may be best conceptualized as dimensional entities that are more similar than different. Despite optimism that the fifth edition of the DSM () would constitute a meaningful shift toward dimensional ED assessment and diagnosis, most changes contribute little movement in that direction. In the present report, we summarize past and anticipate persisting (i.e., in ) limitations of a purely categorical approach to ED diagnosis. We then review our alternative dimensional-categorical profile approach to ED assessment and classification, including preliminary evidence in support of its validity and presentation of two ED profile case examples using our newly developed Multidimensional Emotional Disorder Inventory. We end by discussing the transdiagnostic treatment implications of our profile approach to ED classification and directions for future research.
尽管情感障碍(EDs)在《精神疾病诊断与统计手册》(DSM)中已具备良好的可靠性,但越来越多的证据不断凸显出ED诊断效度方面的局限性。特别是,对跨诊断表型的分类测量、共病及其他描述性精神病理学研究表明,情感障碍或许最好被概念化为维度实体,它们之间的相似性大于差异性。尽管人们乐观地认为《精神疾病诊断与统计手册》第五版(DSM-5)将朝着维度性情感障碍评估与诊断方向实现有意义的转变,但大多数变化在该方向上进展甚微。在本报告中,我们总结了过去纯粹分类法对情感障碍诊断的局限性,并预计这些局限性仍将存在(即存在于DSM-5中)。然后,我们回顾了用于情感障碍评估和分类的维度-分类概况替代方法,并给出支持其效度的初步证据,以及使用我们新开发的多维情感障碍量表呈现的两个情感障碍概况病例示例。最后,我们讨论了情感障碍分类概况方法对跨诊断治疗的启示以及未来研究方向。