Widiger T A, Hurt S W, Frances A, Clarkin J F, Gilmore M
Arch Gen Psychiatry. 1984 Oct;41(10):1005-12. doi: 10.1001/archpsyc.1984.01790210087011.
This study critiques and extends the DSM-III use of fixed and explicit criteria by applying principles and statistics common within actuarial decision theory (eg, conditional probabilities). The value and limitations of sensitivity and specificity rates are discussed and compared with an interesting but rarely used statistic, positive predictive power. The statistics and analyses provided herein also provide an empirical method for developing diagnostic criteria and determining when and how the DSM-III cutoff points might be adjusted, recognize the importance of base rates and utilities to efficient diagnosis, and provide an explicit, quantitative means by which to make optimal differential diagnoses and to make use of the overlap among psychiatric diagnoses. The issues are illustrated in the differential diagnosis of the Borderline Personality Disorder, but they have a relevance to the development and application of the other DSM-III diagnoses.
本研究通过应用精算决策理论中常见的原理和统计方法（如条件概率），对《精神疾病诊断与统计手册》第三版（DSM - III）使用固定且明确标准的做法进行了批判和拓展。文中讨论了灵敏度和特异度率的价值与局限性，并将其与一个有趣但很少使用的统计量——阳性预测值进行了比较。本文提供的统计数据和分析还为制定诊断标准以及确定何时以及如何调整DSM - III的分界点提供了一种实证方法，认识到基础概率和效用对高效诊断的重要性，并提供了一种明确的定量方法，用于进行最佳鉴别诊断以及利用精神疾病诊断之间的重叠。这些问题在边缘型人格障碍的鉴别诊断中得到了说明，但它们与DSM - III中其他诊断的制定和应用也相关。
