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DSM-5-TR 第三部分适应不良人格特质的患者-临床医生报告的一致性和差异:混合门诊样本研究。

Agreement and discrepancies in patient-clinician reports of DSM-5-TR section III maladaptive personality traits: A study on a mixed outpatient sample.

机构信息

Department of General Psychology, University of Padua.

Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence.

出版信息

Personal Disord. 2024 Jan;15(1):94-99. doi: 10.1037/per0000639. Epub 2023 Jul 27.

DOI:10.1037/per0000639
Abstract

The assessment of personality pathology based on dimensional models may improve self-other agreement, but previous research mainly adopted a categorical approach and overlooked the role of the person of the therapist. Our study examined patient-clinician agreement in a mixed sample of Italian outpatients using the Personality Inventory for DSM-5 (PID-5) and the PID-5-Informant Form (PID-5-IRF). Moreover, the role of clinician personality traits on agreement was preliminary explored. Sixty-eight outpatients (51.4% male, = 30.30, = 12.05 years) and their treating clinicians ( = 22; 77.3% female, = 43.77 ± 8.45 years) entered the study. Patients completed the PID-5, whereas clinicians filled-in the PID-5-Brief Form (PID-5-BF) and the PID-5-IRF for each patient they involved. A multilevel Bayesian analysis showed that rank-order agreement was large for domains (mean = .60) and moderate for facets (mean = .44). As regards mean-level agreement, patient ratings on cognitive/perceptual dysregulation, distractibility, eccentricity, and emotional lability were higher than clinician ratings, whereas patients' scores on depressivity were lower than clinicians' ones. Scores on the PID-5-BF detachment positively predicted agreement on anhedonia, anxiousness, depressivity, distractibility, separation insecurity, and suspiciousness, while scores on the PID-5-BF negative affectivity, antagonism, and disinhibition negatively predicted agreement on few specific facets. Current findings suggest that clinician personality traits may contribute to agreement on maladaptive personality traits, but areas of discrepancies remain in case of low observable internal ones. Since patient-clinician agreement is crucially involved in therapeutic alliance, further research on this issue is highly encouraged. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

摘要

基于维度模型的人格病理学评估可能会提高自我-他人的一致性,但先前的研究主要采用分类方法,忽略了治疗师的个体差异。本研究采用人格障碍诊断与统计手册第五版人格量表(PID-5)和 PID-5 知情者评定量表(PID-5-IRF),在意大利混合门诊患者样本中检验了患者-临床医生的一致性。此外,还初步探讨了临床医生人格特质对一致性的作用。68 名门诊患者(51.4%为男性, = 30.30, = 12.05 岁)和他们的治疗医生( = 22;77.3%为女性, = 43.77 ± 8.45 岁)参与了研究。患者完成了 PID-5,而临床医生则为他们所涉及的每位患者填写了 PID-5-简短形式(PID-5-BF)和 PID-5-IRF。多水平贝叶斯分析显示,领域的等级一致性较大(平均 =.60),方面的一致性中等(平均 =.44)。至于平均水平的一致性,患者在认知/知觉失调、注意力分散、古怪和情绪不稳定方面的评分高于临床医生,而患者在抑郁方面的评分低于临床医生。PID-5-BF 超脱得分正预测快感缺失、焦虑、抑郁、注意力分散、分离不安全感和多疑的一致性,而 PID-5-BF 负性情绪、敌对和冲动的得分负预测少数特定方面的一致性。当前的研究结果表明,临床医生的人格特质可能会影响对适应不良人格特质的一致性,但在观察到低内部特质时仍存在差异。由于患者-临床医生的一致性在治疗联盟中至关重要,因此强烈鼓励对此问题进行进一步研究。

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