Blais M A, Hilsenroth M J, Castlebury F D
Department of Psychiatry, Massachusetts General Hospital, Boston, USA.
Compr Psychiatry. 1997 Jan-Feb;38(1):31-7. doi: 10.1016/s0010-440x(97)90050-x.
This study sought to empirically evaluate the content validity of the newly revised DSM-IV narcissistic personality disorder (NPD) and borderline personality disorder (BPD) criteria sets. Using the essential features of each disorder as construct definitions, factor analysis was used to determine how adequately the criteria sets covered the constructs. In addition, this empirical investigation sought to: 1) help define the dimensions underlying these polythetic disorders; 2) identify core features of each diagnosis; and 3) highlight the characteristics that may be most useful in diagnosing these two disorders. Ninety-one outpatients meeting DSM-IV criteria for a personality disorder (PD) were identified through a retrospective analysis of chart information. Records of these 91 patients were independently rated on all of the BPD and NPD symptom criteria for the DSM-IV. Acceptable interrater reliability (kappa estimates) was obtained for both presence or absence of a PD and symptom criteria for BPD and NPD. The factor analysis, performed separately for each disorder, identified a three-factor solution for both the DSM-IV BPD and NPD criteria sets. The results of this study provide strong support for the content validity of the NPD criteria set and moderate support for the content validly of the BPD criteria set. Three domains were found to comprise the BPD criteria set, with the essential features of interpersonal and identity instability forming one domain, and impulsivity and affective instability each identified as separate domains. Factor analysis of the NPD criteria set found three factors basically corresponding to the essential features of grandiosity, lack of empathy, and need for admiration. Therefore, the NPD criteria set adequately covers the essential or defining features of the disorder.
本研究旨在实证评估新修订的《精神疾病诊断与统计手册》第四版（DSM-IV）中自恋型人格障碍（NPD）和边缘型人格障碍（BPD）标准集的内容效度。以每种障碍的基本特征作为结构定义，采用因素分析来确定标准集对这些结构的涵盖程度。此外，这项实证研究旨在：1）帮助界定这些多标准障碍背后的维度；2）识别每种诊断的核心特征；3）突出在诊断这两种障碍时可能最有用的特征。通过对病历信息的回顾性分析，确定了91名符合DSM-IV人格障碍（PD）标准的门诊患者。对这91名患者的病历就DSM-IV中所有的BPD和NPD症状标准进行独立评分。对于PD的存在与否以及BPD和NPD的症状标准，均获得了可接受的评分者间信度（kappa估计值）。针对每种障碍分别进行因素分析，结果显示DSM-IV的BPD和NPD标准集均为三因素解决方案。本研究结果为NPD标准集的内容效度提供了有力支持，为BPD标准集的内容效度提供了适度支持。研究发现BPD标准集由三个领域组成，人际和身份不稳定的基本特征构成一个领域，冲动性和情感不稳定各自被确定为单独的领域。对NPD标准集的因素分析发现三个因素基本对应于夸大、缺乏同理心和需要赞美的基本特征。因此，NPD标准集充分涵盖了该障碍的基本或定义性特征。
