Torres-Rosado Lidia, Lozano Oscar M, Sanchez-Garcia Manuel, Fernández-Calderón Fermín, Diaz-Batanero Carmen
Department of Clinical and Experimental Psychology, University of Huelva, Huelva 21071, Spain.
Research Center for Natural Resources, Health and Environment, University of Huelva, Huelva 21071, Spain.
World J Psychiatry. 2023 Jun 19;13(6):278-297. doi: 10.5498/wjp.v13.i6.278.
Measurement of externalizing disorders such as antisocial disorders, attention-deficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) have provided the diagnostic framework for decades, recent dimensional frameworks question the categorical approach of psychopathology, inherent in traditional nosotaxies. Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach, providing diagnostic labels. In contrast, dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum, but are less widely used in practice. Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks, revise the different measurement alternatives existing, and provide an integrative operational definition. First, an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology (HiTOP) model is carried out. Then, in order to analyze the coverage of operational definitions found, a description of measurement instruments among each conceptualization is provided. Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement. ICD and DSM versions have progressively introduced systematicity, providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development. However, it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders, and therefore their measurement. More recent theoretical approaches, such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems. Nevertheless, several issues concerning this model raise mesasurement challenges. A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments. Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed. The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.
诸如反社会障碍、注意力缺陷多动障碍或边缘性障碍等外化性障碍的测量，对患有这些障碍的人的日常生活具有重要意义。几十年来，《精神疾病诊断与统计手册》（DSM）和《国际疾病分类》（ICD）提供了诊断框架，但最近的维度框架对传统疾病分类法中固有的精神病理学分类方法提出了质疑。在DSM或ICD框架下开发的测试和工具优先采用这种分类方法，提供诊断标签。相比之下，维度测量工具为构成外化谱系的各个领域提供个性化概况，但在实践中的应用并不广泛。本文旨在回顾在这些不同框架下定义的外化性障碍的操作定义，修订现有的不同测量方法，并提供一个综合的操作定义。首先，对DSM/ICD诊断系统和最近的精神病理学层次分类法（HiTOP）模型中外化性障碍的操作定义进行分析。然后，为了分析所发现的操作定义的涵盖范围，对每种概念化中的测量工具进行描述。可以观察到ICD和DSM诊断系统发展的三个阶段，这对测量有直接影响。ICD和DSM版本逐渐引入了系统性，对诊断标准和类别进行了更详细的描述，这便于测量工具的开发。然而，有人质疑DSM/ICD系统是否能充分对外化性障碍进行建模，进而对其测量进行建模。更新的理论方法，如HiTOP模型，试图克服对分类系统提出的一些批评。然而，关于该模型的几个问题带来了测量挑战。对每种方法下的工具进行修订后发现，现有工具对外化性障碍的覆盖并不完整。仍需要努力将疾病分类法与精神病理学和人格的其他理论模型结合起来。所提供的外化性障碍的综合操作定义可能有助于汇集临床实践和研究。
