Holdwick D J, Hilsenroth M J, Castlebury F D, Blais M A
Department of Psychology, University of Arkansas, Fayetteville 72701, USA.
Compr Psychiatry. 1998 Sep-Oct;39(5):277-86. doi: 10.1016/s0010-440x(98)90036-0.
A clinical chart-review study of the Cluster B personality disorders (PDs) was conducted to evaluate the specificity of DSM-IV criteria for the Antisocial Personality Disorder (ANPD), Borderline Personality Disorder (BPD), and Narcissistic Personality Disorder (NPD). Eight-six outpatients meeting DSM-IV criteria for a PD were identified through a retrospective chart-review procedure. Records of these 86 patients were independently rated on all of the ANPD, BPD, and NPD symptom criterion for the DSM-IV. High interrater reliabilities were obtained for the presence or absence of a PD and symptom criteria for ANPD, BPD, and NPD (all kappa > or = .80). The sample consisted of ANPD (n = 20), BPD (n = 25), NPD (n = 15), and other personality disorders (OPD; Cluster A and C; n = 26). Five ANPD criteria reliably differentiated ANPD patients from BPD and NPD patients (1, 2, 3, 6, 7), and two criteria did not differentiate this group from either intracluster category (4, 5). BPD criteria also differentiated BPD patients from ANPD and NPD patients; however, the specific criteria that effectively differentiated categories were dependent on the group comparisons. BPD criteria (1, 2, 3, 6, 7) differentiated BPD and ANPD patients. BPD and NPD patients could be discriminated on other BPD criteria (2, 3, 5, 6, 7, 8). NPD criteria showed a similar ability to differentiate patients. NPD criteria differentiated NPD and BPD patients on DSM-IV criteria of 1, 3, 4, 5, 7, and 9. NPD and ANPD patients could be differentiated on other NPD criteria (1, 2, 3, 4, 5, 9). The results of this study provide general support for the use of specific criteria for these three disorders in the differential comparison of related and unrelated PDs. The utility of items that describe essential features are discussed.
开展了一项关于B类人格障碍（PDs）的临床病历回顾研究，以评估《精神疾病诊断与统计手册》第四版（DSM-IV）中反社会型人格障碍（ANPD）、边缘型人格障碍（BPD）和自恋型人格障碍（NPD）标准的特异性。通过回顾性病历审查程序，确定了86名符合DSM-IV人格障碍标准的门诊患者。对这86名患者的病历，就DSM-IV中所有的ANPD、BPD和NPD症状标准进行了独立评级。对于人格障碍的存在与否以及ANPD、BPD和NPD的症状标准，评定者间信度较高（所有kappa系数>或=0.80）。样本包括ANPD患者（n = 20）、BPD患者（n = 25）、NPD患者（n = 15）以及其他人格障碍患者（OPD；A类和C类；n = 26）。五条ANPD标准能可靠地将ANPD患者与BPD和NPD患者区分开来（标准1、2、3、6、7），两条标准无法将该组患者与聚类内的任何类别区分开来（标准4、5）。BPD标准也能将BPD患者与ANPD和NPD患者区分开来；然而，有效区分各分类的具体标准取决于组间比较。BPD标准（标准1、2、3、6、7）能区分BPD和ANPD患者。BPD和NPD患者可根据其他BPD标准（标准2、3、5、6、7、8）进行区分。NPD标准显示出类似的区分患者的能力。NPD标准依据DSM-IV标准1、3、4、5、7和9区分NPD和BPD患者。NPD和ANPD患者可根据其他NPD标准（标准1、2、3、4、5、9）进行区分。本研究结果为在相关和不相关人格障碍的鉴别比较中使用这三种障碍的特定标准提供了总体支持。讨论了描述基本特征的条目的效用。
