Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6018, USA; email:
Annu Rev Clin Psychol. 2019 May 7;15:179-205. doi: 10.1146/annurev-clinpsy-050718-095644.
Is there a clear line between normal and abnormal mood? Studies of manifest and latent structure provide strong support for a continuum that extends from asymptomatic to subsyndromal to syndromal cases of increasing severity. Subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor's visits and suicide attempts than the full syndromes, yet they are not recognized in the current classification. For most research and some clinical activities, dimensional diagnoses are recommended, and examples are offered for how such diagnoses could be made. For clinical activities requiring decisions, a multithreshold model is proposed in which both lower (e.g., mild depression, capturing subsyndromal cases) and upper (e.g., major depression, capturing clinically significant cases) diagnostic categories are used to inform clinical care. Beyond its implications for diagnosis, the dimensionality of depression and anxiety has implications for etiology and for research aimed at understanding how emotions become disrupted in psychopathology.
正常情绪和异常情绪之间是否有明确的界限？明显和潜在结构的研究为一个连续体提供了强有力的支持，这个连续体从无症状延伸到亚综合征，再到综合征，严重程度逐渐增加。亚综合征症状会造成损害，预示着综合征的发作和复发，并导致比完整综合征更多的就诊和自杀企图，但它们在当前的分类中没有得到认可。对于大多数研究和一些临床活动，推荐使用维度诊断，并提供了如何进行这种诊断的例子。对于需要决策的临床活动，提出了一个多阈值模型，其中使用较低的（例如，轻度抑郁，捕捉亚综合征病例）和较高的（例如，重度抑郁，捕捉临床显著病例）诊断类别来为临床护理提供信息。除了对诊断的影响外，抑郁和焦虑的维度对病因学以及旨在了解情绪在精神病理学中是如何失调的研究都有影响。
