人格障碍诊断与评估的研究进展

New direction in diagnosis and assessment of personality disorders

《精神疾病诊断与统计手册》第一版(the first edition of Diagnostic and Statistical Manual of Mental Disorders,DSM-1)正式提出人格障碍的诊断;DSM-3开创性地提出了用一个系统的框架来理解人格障碍,并提出了多轴诊断策略、类别诊断标准;之后的DSM系统关于人格障碍的诊断沿用了DSM-3的策略与标准。2013年出版的DSM-5,在沿用以往的人格障碍诊断标准的同时提出了人格障碍替代模式(alternative model for personality disorders,AMPD),表明了人格障碍诊断和评估新的发展方向。AMPD强调用标准A即自我及人际功能损害来预测人格障碍的严重性,用标准B即病理性人格特质来鉴别不同的人格障碍类型。标准A的内容可追溯到心理动力学的概念,比如Kernberg人格组织模型中提到的自体与客体的区分与整合。AMPD提出了分别用于评估人格功能损害程度、病理性人格特质的人格障碍评估工具:人格功能水平量表(Level of Personality Functioning Scale,LPFS)、DSM-5人格量表,并进行了信度和效度检验。基于Kernberg人格组织模型的人格障碍评估工具人格组织结构化访谈问卷被证明与LPFS有良好的相关性。

The diagnosis of personality disorders was formally presented in the first edition of Diagnostic and Statistical Manual of Mental Disorders(DSM-1).DSM-3 proposed a systematic framework for understanding personality disorders,and mentioned the multi-axis diagnosis strategy and category diagnosis criteria.The following editions of DSM still mentioned the strategy and criteria.DSM-5,published in 2013,mentioned the alternative model for personality disorders(AMPD),which indicated a new direction in the diagnosis and assessment of personality disorders.AMPD had a dimensional assessment of the severity of personality pathology(criterion A),and a dimensional assessment of features of personality pathology(criterion B).The criterion A was influenced by the concepts of psychodynamics,like the distinction and integration of self and object in the Kernberg model of personality organization.Level of Personality Functioning Scale(LPFS)and Personality Inventory for DSM-5 were developed to assess personality disorders mentioned in AMPD.The reliability and validity of the tools were demonstrated.Structured Interview of Personality Organization,an assessment tool based on Kernberg model of personality organization,was proved to have significant correlation with LPFS.