The revisions proposed for the DSM-5 would greatly alter how personality pathology is conceptualized, assessed, and diagnosed. One aspect of the proposed changes, elimination of four current personality disorders, has raised considerable controversy. The present study attempts to inform this debate by exploring clinicians' views of the structure of Personality Disorders using the current diagnostic system, the DSM-IV. An exploratory factor analysis was conducted on the DSM-IV Personality Disorder criteria using clinician ratings for 280 patients. The factor analysis revealed eight clear and meaningful factors. The eight factors contained all six personality disorders proposed for retention in DSM-5 but also contained clear representations of two disorders (Paranoid and Schizoid) identified for removal from the system. These conditions appear to have clinical utility and their removal may have unintended negative consequences in clinical practice. Dependent and Avoidant criteria also merged to form a new construct with interesting clinical implications. These findings provide new insights into the complex typologies clinicians employ when applying the DSM-IV system to personality disordered patients. Lastly we argue that successful refinement of clinically significant constructs, like diagnostic systems, requires a balanced appraisal of evidence for clinical utility as well as external and internal validity.

译文

:针对DSM-5提出的修订将极大地改变人格病理学的概念化,评估和诊断方式。所提议的改变的一方面,消除了当前的四种人格障碍,引起了相当大的争议。本研究试图通过使用当前的诊断系统DSM-IV探索临床医生对人格障碍结构的看法来为这场辩论提供信息。使用临床医师评估的280名患者,对DSM-IV人格障碍标准进行了探索性因素分析。因素分析揭示了八个明确而有意义的因素。八个因素既包含提议保留在DSM-5中的所有六个人格障碍,也包含明确识别出的两种人格障碍(Paranoid和Schizoid),可以从系统中移除。这些情况似乎具有临床用途,将其清除可能会在临床实践中产生意想不到的负面影响。受抚养者和回避者的标准也合并在一起,形成了一种具有有趣临床意义的新结构。这些发现为临床医生在将DSM-IV系统应用于人格障碍患者时采用的复杂类型提供了新的见解。最后,我们认为要成功地完善具有临床意义的结构(如诊断系统),需要对临床实用性以及内部和外部有效性的证据进行均衡的评估。

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