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1 2013, Vol. 21, No. 6, Advances in Psychological Science DOI: /SP.J * 强迫症诊断研究的新变化 (, ) 临床实践与相关研究表明, 强迫症的诊断标准已不能满足复杂的临床工作需要首先, 有关患者的自知力以及主观痛苦程度等诊断指标需要进一步修订其次, 就强迫症的核心症状而产生的争议, 研究者提出应重新考虑强迫症焦虑障碍强迫谱系障碍和囤积障碍这四个概念之间的从属关系和诊断标准未来研究应考虑从认知神经科学的视角探索强迫症的核心症状和病理机制, 为强迫症的诊断标准提供新的依据强迫症 ; 焦虑障碍 ; 强迫谱系障碍 ; 囤积障碍 B845 1 引言 (obsessive-compulsive disorder, OCD), / (American Psychiatric Association, 2000) 1.6% (Kessler et al., 2005) 0.7% (Horwath & Weissman, 2000) , 0.03% (,,, 2003) (Chinese Classification of Mental Disorders, CCMD), (International Classification of Disease, ICD-10) (Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR),,, Crino DSM-III DSM-IV, DSM-III, 2.1%, : * SYS :, wjphh@bnu.edu.cn DSM-IV 0.6%, 3 (Crino, Slade, & Andrews, 2005),,,, (body dysmorphic disorder, BDD), (obsessive-compulsive spectrum disorder);, DSM-IV,,,, ;,,,,, 1041

考虑从认知神经科学的视角探索强迫症的核心症状和病理机制, 为强迫症的诊断标准提供新的依据强迫症 ; 焦虑障碍 ; 强迫谱系障碍 ; 囤积障碍 B845 1 引言 (obsessive-compulsive disorder, OCD), / (American Psychiatric

2 ,, 2 强迫症诊断标准的争论 2.1 强迫症的定义 DSM-IV,, ;,,,, (American Psychiatric Association, 2000) ICD-10,,, ICD-10, DSM-IV, DSM-IV 2.2 对诊断标准表达方式的争议 DSM-IV 1(American Psychiatric Association, 2000) (ego-dystonic), DSM-IV (inappropriate),,, (unwanted) (Leckman et al., 2010), (Foa et al., 2005; Mancebo et al., 2008; Pediatric, 2004), 122,, 12.3%; 41.8%, 43.4%, 2.5% (Foa et al., 2005),,,,, (Leckman et al., 2010) 2.3 对诊断标准维度的争论 DSM-IV-TR, 5 ( 1),, 自知力是诊断强迫症的前提吗? 有关自知力的研究 (insight) ;, (Eisen, Phillips, Coles, & Rasmussen, 2004; Foa et al., 1995), Eisen 2% 一天花费时间在 1 小时以上标准有充分依据吗? 有关主观痛苦程度 DSM-IV C 1, 1,,, 1 1,, 1, (De Bruijn, Beun, De Graaf, Ten Have, & Denys, 2010; Fullana et al., 2009),,

, 2008; Pediatric, 2004), 122,, 12.3%; 41.8%, 43.4%, 2.5% (Foa et al., 2005),,,,, (Leckman et al., 2010) 2.3 对诊断标准维度的争论 DSM-IV-TR, 5 ( 1),, 2.3.1 自知力是诊断强迫症的前提吗?

3 6 : 1043 表 1 DSM-IV 强迫症的诊断标准 A., (1), ; (2) ; (3), ; (4) ( ) ) ( ) (1)(, ) (, ); (2);, B., C., ( 1 ) ( ) D. I, (, ; ; ; ; ; ; ) E. ( ), 3,, 1 3 强迫症与焦虑障碍强迫谱系障碍的关系 (Diagnostic and Statistical Manual of Mental Disorders, DSM-5), DSM 187, 60%, 40%, 75%, 40%~45% ( ) (Mataix-Cols, Pertusa, & Leckman, 2007),,, (Stein et al., 2010) (Storch, Abramowitz, & Goodman, 2008) 3.1 强迫症与强迫谱系障碍 (obsessive-compulsive spectrum disorder) (hypochondriasis) (chronic tic disorders), (skin picking), (Abramowitz, McKay, & Taylor, 2008) (, ) (,, ),, 1/3

40%~45% ( ) (Mataix-Cols, Pertusa, & Leckman, 2007),,, (Stein et al., 2010) (Storch, Abramowitz, & Goodman, 2008) 3.

4 , 1/4 3 8 (Phillips et al., 2010),,, 40% (Didie, Menard, Stern, & Phillips, 2008) Richter, (Richter, Summerfeldt, Antony, & Swinson, 2003) / (tic chronic disorder),,, (Coles, Pinto, Mancebo, Rasmussen, & Eisen, 2008; Hasler et al., 2005; Peterson, Pine, Cohen, & Brook, 2001; Samuels et al., 2007; Wheaton, Timpano, LaSalle-Ricci, & Murphy, 2008); / 3.2 强迫症与焦虑障碍 DSM-III DSM-III-TR DSM-IV DSM-IV-TR,, ( ) ( ),,,, (Bartz & Hollander, 2006),,, (Nutt & Malizia, 2006),,, (Arntz, Voncken, & Goosen, 2007; MacDonald & Davey, 2005) 3.3 强迫症与囤积障碍 Frost Gross (1993), DSM-IV-TR (Mataix-Cols et al., 2010),,,,, ( ) (Abramowitz, Franklin, & Foa, 2002; Leckman, Rauch, & Mataix-Cols, 2007; Mataix-Cols, Marks, Greist, Kobak, & Baer, 2002) (Mataix-Cols et al., 2002) (Frost, Steketee, & Tolin, 2012),,,, 4 有关强迫症病理机制的认知神经科学研究, (Frances & Widiger, 2012) Hyman (Hyman, 2007) (Kupfer & Regier, 2011)

et al., 2005; Peterson, Pine, Cohen, & Brook, 2001; Samuels et al., 2007; Wheaton, Timpano, LaSalle-Ricci, & Murphy, 2008); / 3.

5 6 : 1045, (, 2006) (van Grootheest, Boomsma, Hettema, & Kendler, 2008), 1383, 3 (rumination), /, 3, 36%, 64% / / /, (probands), / / (Alsobrook et al., 2000; Hasler et al., 2007),,, (Hyman, 2007), 5 评价与展望, (Stasik, Naragon-Gainey, Chmielewski, & Watson, 2012),,, 蔡厚德. (2006). 强迫症的脑功能障碍. 心理科学进展, 14(3), 郭慧荣, 肖泽萍, 张海音. (2003). 强迫症流行病学研究进展. 上海精神医学, 15(3), Abramowitz, J. S., Franklin, M. E., & Foa, E. B. (2002). Empirical status of cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analytic review. Romanian Journal of Cognitive & Behavioral Psychotherapies; Romanian Journal of Cognitive & Behavioral Psychotherapies. Abramowitz, J. S., McKay, D., & Taylor, S. (2008). Obsessive-compulsive disorder: Subtypes and spectrum conditions. New York: Elsevier. Alsobrook, J. P., II., Leckman, J. F., Goodman, W. K., Rasmussen, S. A., & Pauls, D. L. (2000). Segregation analysis of obsessive-compulsive disorder using symptom-based factor scores. American Journal of Medical Genetics, 88(6), American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Publishing, Inc. Arntz, A., Voncken, M., & Goosen, A. C. A. (2007). Responsibility and obsessive-compulsive disorder: An experimental test. Behaviour Research and Therapy, 45, Bartz, J. A., & Hollander, E. (2006). Is obsessive-compulsive disorder an anxiety disorder? Progress in Neuro-Psychopharmacology and Biological Psychiatry, 30(3), Coles, M. E., Pinto, A., Mancebo, M. C., Rasmussen, S. A., & Eisen, J. L. (2008). OCD with comorbid OCPD: A subtype of OCD? Journal of Psychiatric Research, 42(4), Crino, R., Slade, T., & Andrews, G. (2005). The changing prevalence and severity of obsessive-compulsive disorder criteria from DSM-III to DSM-IV. American Journal of

强迫症流行病学研究进展. 上海精神医学, 15(3), 179 182. Abramowitz, J. S., Franklin, M. E., & Foa, E. B. (2002).

6 Psychiatry, 162(5), De Bruijn, C., Beun, S., De Graaf, R., Ten Have, M., & Denys, D. (2010). Subthreshold symptoms and obsessive-compulsive disorder: Evaluating the diagnostic threshold. Psychological Medicine, 40(6), Didie, E. R., Menard, W., Stern, A. P., & Phillips, K. A. (2008). Occupational functioning and impairment in adults with body dysmorphic disorder. Comprehensive Psychiatry, 49(6), Eisen, J. L., Phillips, K. A., Coles, M. E., & Rasmussen, S. A. (2004). Insight in obsessive compulsive disorder and body dysmorphic disorder. Comprehensive Psychiatry, 45(1), Foa, E. B., Kozak, M. J., Goodman, W. K., Hollander, E., Jenike, M. A., & Rasmussen, S. A. (1995). DSM-IV field trial: Obsessive-compulsive disorder. The American Journal of Psychiatry, 152, Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E.,... Schmidt, A. B. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), Frances, A. J., & Widiger, T. (2012). Psychiatric diagnosis: Lessons from the DSM-IV past and cautions for the DSM-5 future. Annual Review of Clinical Psychology, 8, Frost, R. O., & Gross, R. C. (1993). The hoarding of possessions. Behaviour Research and Therapy, 31(4), Frost, R. O., Steketee, G., & Tolin, D. F. (2012). Diagnosis and assessment of hoarding disorder. Annual Review of Clinical Psychology, 8, Fullana, M., Mataix-Cols, D., Caspi, A., Harrington, H., Grisham, J., Moffitt, T., & Poulton, R. (2009). Obsessions and compulsions in the community: Prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. American Journal of Psychiatry, 166(3), Hasler, G., LaSalle-Ricci, V. H., Ronquillo, J. G., Crawley, S. A., Cochran, L. W., Kazuba, D.,... Murphy, D. L. (2005). Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Research, 135(2), Hasler, G., Pinto, A., Greenberg, B. D., Samuels, J., Fyer, A. J., Pauls, D.,... Murphy, D. L. (2007). Familiality of factor analysis-derived YBOCS dimensions in OCD-affected sibling pairs from the OCD Collaborative Genetics Study. Biological Psychiatry, 61(5), Horwath, E., & Weissman, M. M. (2000). The epidemiology and cross-national presentation of obsessive-compulsive disorder. Psychiatric Clinics of North America, 23(3), Hyman, S. E. (2007). Can neuroscience be integrated into the DSM-V? Nature Reviews Neuroscience, 8(9), Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593. Kupfer, D. J., & Regier, D. A. (2011). Neuroscience, clinical evidence, and the future of psychiatric classification in DSM-5. American Journal of Psychiatry, 168(7), Leckman, J. F., Denys, D., Simpson, H. B., Mataix-Cols, D., Hollander, E., Saxena, S.,... Stein, D. J. (2010). Obsessive-compulsive disorder: A review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depress Anxiety, 27(6), Leckman, J. F., Rauch, S. L., & Mataix-Cols, D. (2007). Symptom dimensions in obsessive-complusive disorder: Implications for the DSM-V. CNS Spectr, 12(5), ,400. MacDonald, B., & Davey, G. C. L. (2005). Inflated responsibility and perseverative checking: The effect of negative mood. Journal of Abnormal Psychology, 114(1), Mancebo, M. C., Greenberg, B., Grant, J. E., Pinto, A., Eisen, J. L., Dyck, I., & Rasmussen, S. A. (2008). Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder. Comprehensive Psychiatry, 49(1), Mataix-Cols, D., Marks, I. M., Greist, J. H., Kobak, K. A., & Baer, L. (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial. Psychotherapy and Psychosomatics, 71(5), Mataix-Cols, D., Pertusa, A., & Leckman, J. (2007). Issues for DSM-V: How should obsessive-compulsive and related disorders be classified? American Journal of Psychiatry, 164(9), Mataix-Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F.,... Wilhelm, S. (2010). Hoarding disorder: a new diagnosis for DSM V? Depression and Anxiety, 27(6), Nutt, D., & Malizia, A. (2006). Anxiety and OCD-the chicken or the egg? Journal of Psychopharmacology, 20(6), Pediatric, O. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with

Occupational functioning and impairment in adults with body dysmorphic disorder. Comprehensive Psychiatry, 49(6), 561 569. Eisen, J. L., Phillips, K. A., Coles, M. E., & Rasmussen, S. A. (2004).

7 6 : 1047 obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA: The Journal of the American Medical Association, 292(16), Peterson, B. S., Pine, D. S., Cohen, P., & Brook, J. S. (2001). Prospective, longitudinal study of tic, obsessivecompulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample. Journal-American Academy of Child and Adolescent Psychiatry, 40(6), Phillips, K. A., Wilhelm, S., Koran, L. M., Didie, E. R., Fallon, B. A., Feusner, J., & Stein, D. J. (2010). Body dysmorphic disorder: Some key issues for DSM V. Depress Anxiety, 27(6), Richter, M. A., Summerfeldt, L. J., Antony, M. M., & Swinson, R. P. (2003). Obsessive-compulsive spectrum conditions in obsessive-compulsive disorder and other anxiety disorders. Depression and Anxiety, 18(3), Samuels, J. F., Bienvenu 3rd, O., Pinto, A., Fyer, A. J., McCracken, J. T., Rauch, S. L.,... Nestadt, G. (2007). Hoarding in obsessive-compulsive disorder: Results from the OCD Collaborative Genetics Study. Behaviour Research and Therapy, 45(4), Stasik, S. M., Naragon-Gainey, K., Chmielewski, M., & Watson, D. (2012). Core OCD Symptoms: Exploration of specificity and relations with psychopathology. Journal of Anxiety Disorders, 26, Stein, D. J., Fineberg, N. A., Bienvenu, O. J., Denys, D., Lochner, C., Nestadt, G.,... Phillips, K. A. (2010). Should OCD be classified as an anxiety disorder in DSM V? Depression and Anxiety, 27(6), Storch, E. A., Abramowitz, J., & Goodman, W. K. (2008). Where does obsessive-compulsive disorder belong in DSM V? Depression and Anxiety, 25(4), van Grootheest, D. S., Boomsma, D. I., Hettema, J. M., & Kendler, K. S. (2008). Heritability of obsessivecompulsive symptom dimensions. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 147(4), Wheaton, M., Timpano, K. R., LaSalle-Ricci, V. H., & Murphy, D. L. (2008). Characterizing the hoarding phenotype in individuals with OCD: Associations with comorbidity, severity and gender. Journal of Anxiety Disorders, 22(2), The New Development of Diagnostic Research of Obsessive-Compulsive Disorder SUN Ling; WANG Jianping (School of psychology, Beijing Normal University, Beijing Key Lab of Applied Experimental Psychology, Beijing , China) Abstract: Whereas evdence from clinical practice and research suggests that current diagnostic criteria of obsessive-compulsive disorder (OCD) have not met the need of therapists work, more clirifications are needed to be discussed about the patients insight and clinical significance criterion. Considering the debate about the core symptom of OCD, researchers proposed that it s necessary to reconsiderate the relationship among the OCD, anxiety disorder, obsessive-compulsive spectrum disorder and hoarding disorder. Furture research should identify the core symptoms of OCD in the perspective of cognitive neuroscience and provide a basis for the OCD diagnostic standard. Key words: obsessive-compulsive disorder; anxiety disorder; obsessive-compulsive spectrum disorder; hoarding disorder

Journal-American Academy of Child and Adolescent Psychiatry, 40(6), 685 695. Phillips, K. A., Wilhelm, S., Koran, L. M., Didie, E. R., Fallon, B. A., Feusner, J., & Stein, D. J. (2010).

目錄廣州中山大學翻譯學院 ( 珠海校區 ) 學生論文 1. 淺談湘西農村義務教育之現狀以湘西吉首矮寨中小學為例作者 : 劉陽荷 ( 翻譯系 ) 2. 國內大學生對囤積症的認知作者

目錄廣州中山大學翻譯學院 ( 珠海校區 ) 學生論文 1. 淺談湘西農村義務教育之現狀以湘西吉首矮寨中小學為例作者 : 劉陽荷 ( 翻譯系 ) 2. 國內大學生對囤積症的認知作者 Cross-cultural Studies: 7th Annual Research Presentations 第七屆跨文化專題 : 學生研究發表論文集 Partner Based Learning 主辦單位 : 輔仁大學執行單位 : 輔仁大學社會科學院國際夥伴學習推展中心協辦單位 : 廣州中山