Sharp Carla, Clark Lee Anna, Balzen Kennedy M, Widiger Tom, Stepp Stephanie, Zimmerman Mark, Krueger Robert F
Department of Psychology, University of Houston, Houston, TX, USA.
Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.
World Psychiatry. 2025 Oct;24(3):319-340. doi: 10.1002/wps.21339.
A substantial body of empirical evidence has accumulated over the last 12 years since the publication of the Alternative Model for Personality Disorders (AMPD) in the DSM-5. As yet, this evidence has not been organized and reported using the criteria required by the American Psychiatric Association (APA) for proposals submitted to revise the DSM-5. These criteria are based on the Kendler-Kupfer update and expansion of the classic Robins-Guze criteria for establishing psychiatric diagnostic validity. We have been invited by the APA to undertake a review of the last decade of research on the AMPD and to propose a revised, simplified version of the model informed by this evidence. Here we present the findings of the review and our recommendations for the revision of the model. We begin with a brief reiteration of the background and rationale for the AMPD, followed by a description of the revision criteria required by the APA. We then summarize the evidence in support of the AMPD using the required framework. Our review indicates that AMPD-defined personality disorder (PD) shows similar patterns of associations as have been demonstrated for categorical PD diagnoses in terms of antecedent, concurrent and predictive validators. Head-to-head comparisons between AMPD-defined PD and categorical diagnoses suggest a more precise characterization of personality pathology by the AMPD. In addition, AMPD-defined PD appears to show higher reliability estimates than categorical PDs, and strong clinical utility, often outperforming categorical PD diagnoses. We conclude that the AMPD is ready for inclusion in the main section of the DSM. Recommendations are made for: a) further streamlining the AMPD in light of the last decade of accumulated evidence, and b) future research directions in areas where evidence is lacking or more limited.
自《精神疾病诊断与统计手册》第五版（DSM - 5）中人格障碍替代模型（AMPD）发布以来的12年里，积累了大量实证证据。然而，这些证据尚未按照美国精神病学协会（APA）要求的标准进行整理和报告，这些标准适用于提交给修订DSM - 5的提案。这些标准基于肯德勒 - 库普弗对经典罗宾斯 - 古兹标准的更新和扩展，用于确立精神疾病诊断的有效性。我们受APA邀请，对过去十年关于AMPD的研究进行综述，并根据这些证据提出一个修订后的、简化版的模型。在此，我们展示综述结果以及对模型修订的建议。我们首先简要重申AMPD的背景和基本原理，接着描述APA要求的修订标准。然后，我们使用所需框架总结支持AMPD的证据。我们的综述表明，AMPD定义的人格障碍（PD）在前因、共时和预测验证方面，显示出与分类PD诊断相似的关联模式。AMPD定义的PD与分类诊断之间的直接比较表明，AMPD对人格病理学的描述更为精确。此外，AMPD定义的PD似乎比分类PD具有更高的信度估计，且具有强大的临床实用性，通常优于分类PD诊断。我们得出结论，AMPD已准备好纳入DSM的主要部分。针对以下方面提出建议：a）根据过去十年积累的证据进一步简化AMPD；b）在证据缺乏或更有限的领域确定未来研究方向。
