Westen D, Shedler J
Department of Psychiatry, Harvard Medical School, Boston, USA.
Am J Psychiatry. 1999 Feb;156(2):258-72. doi: 10.1176/ajp.156.2.258.
Personality pathology is difficult to measure. Current instruments have problems with validity and rely on a direct-question format that may be inappropriate for the assessment of personality. In addition, they are designed specifically to address current DSM-IV categories and criteria, which limits their utility in making meaningful revisions of those criteria. These problems suggest the need for consideration of alternative approaches to assessing and revising axis II.
This article describes the development and validation of an assessment tool designed to allow clinicians to provide detailed, clinically rich personality descriptions in a systematic and quantifiable form (the Shedler-Westen Assessment Procedure, or SWAP-200). A total of 797 randomly selected psychiatrists and psychologists used the SWAP-200 to describe either an actual patient or a hypothetical, prototypical patient with one of 14 personality disorders (one of the 10 DSM-IV axis II disorders or one of four disorders included in the appendix or in DSM-III-R) or a healthy, high-functioning patient.
The data yielded aggregated descriptions of actual patients in each diagnostic category (N = 530) as well as aggregated descriptions of hypothetical, prototypical patients (N = 267). SWAP-200 descriptions of patients with personality disorders showed high convergent and discriminant validity on a variety of criteria. The diagnostic procedure lends itself to both categorical and dimensional personality disorder diagnoses. Descriptions of individual patients resemble MMPI profiles, based on the degree of match between the patient's profile and a criterion group, except that they are based on clinician observation rather than self-report.
The SWAP-200 represents an approach to the measurement and classification of personality disorders that has potential for refining axis II categories and criteria empirically in ways that are both psychometrically and clinically sound.
人格病理学难以测量。当前的工具存在效度问题，且依赖直接提问的形式，这可能不适用于人格评估。此外，它们是专门为符合当前《精神疾病诊断与统计手册第四版》（DSM-IV）的类别和标准而设计的，这限制了它们在对这些标准进行有意义修订方面的效用。这些问题表明需要考虑评估和修订轴II的替代方法。
本文描述了一种评估工具的开发与验证，该工具旨在让临床医生能够以系统且可量化的形式提供详细、富含临床信息的人格描述（即舍德勒-韦斯顿评估程序，或SWAP-200）。总共797名随机挑选的精神科医生和心理学家使用SWAP-200来描述一名实际患者或一名具有14种人格障碍之一（10种DSM-IV轴II障碍之一、附录中包含的4种障碍之一或DSM-III-R中的障碍之一）的假设的典型患者，或一名健康、功能良好的患者。
数据得出了每个诊断类别的实际患者（N = 530）的综合描述以及假设的典型患者（N = 267）的综合描述。SWAP-200对人格障碍患者的描述在各种标准上显示出高度的聚合效度和区分效度。该诊断程序适用于类别和维度性人格障碍诊断。基于患者概况与标准组之间的匹配程度，个体患者的描述类似于明尼苏达多相人格调查表（MMPI）概况，不同之处在于它们基于临床医生的观察而非自我报告。
SWAP-200代表了一种人格障碍的测量和分类方法，有潜力以心理测量学和临床合理的方式，凭经验完善轴II的类别和标准。
