Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
Clin Psychol Rev. 2020 Aug;80:101889. doi: 10.1016/j.cpr.2020.101889. Epub 2020 Jul 9.
It is often argued that successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have relaxed diagnostic criteria and thereby inflated rates of diagnosis. This claim has yet to be examined systematically. We quantitatively reviewed 123 studies in which one sample was concurrently diagnosed using two consecutive DSM editions (i.e., DSM-III & DSM-III-R, DSM-III-R & DSM-IV, or DSM-IV & DSM-5). Meta-analysis of 476 risk ratios enabled 123 comparisons of diagnostic rates for specific disorders. Comparisons demonstrating diagnostic inflation (i.e., higher diagnostic rate in the later edition) did not exceed those demonstrating deflation. The average risk ratio was 1.00, indicating no overall change in diagnostic stringency from DSM-III to DSM-5, and there were no reliable tendencies for particular DSM revisions to be more inflationary or deflationary than others. Specific disorders showing reliable evidence of diagnostic inflation or deflation were identified. Notable examples of diagnostic inflation included Attention-Deficit/Hyperactivity Disorder (ADHD), autism, eating disorders, and substance dependence. Although serious concerns have been raised about diagnostic inflation or "concept creep" in the DSM, these concerns may have been overstated.
人们常说，《精神障碍诊断与统计手册》（DSM）的连续版本放宽了诊断标准，从而导致了诊断率的膨胀。但这一说法尚未得到系统的检验。我们对 123 项研究进行了定量综述，这些研究在同一组样本中同时使用了两个连续的 DSM 版本进行诊断（即 DSM-III 与 DSM-III-R、DSM-III-R 与 DSM-IV 或 DSM-IV 与 DSM-5）。对 476 个风险比进行元分析后，我们对 123 项特定障碍的诊断率进行了比较。显示诊断膨胀（即，后期版本的诊断率更高）的比较并不超过显示诊断紧缩的比较。平均风险比为 1.00，表明从 DSM-III 到 DSM-5，诊断严格性总体上没有变化，而且特定的 DSM 修订版本没有比其他版本更具膨胀性或紧缩性的可靠趋势。确定了显示出可靠的诊断膨胀或紧缩证据的特定障碍。诊断膨胀的显著例子包括注意力缺陷/多动障碍（ADHD）、自闭症、饮食障碍和物质依赖。尽管人们对 DSM 中的诊断膨胀或“概念蔓延”提出了严重关切，但这些关切可能被夸大了。
