2013, Vol. 21, No. 11, 1967 1975 Advances in Psychological Science DOI: 10.3724/SP.J.1042.2013.01967 * 从 DSM-Ⅳ 躯 体 形 式 障 碍 到 DSM-5 躯 体 症 状 障 碍 (, 300071) DSM-Ⅳ 是 使 用 最 广 泛 的 精 神 障 碍 诊 断 标 准 之 一, 但 其 中 的 躯 体 形 式 障 碍 诊 断 标 准 在 临 床 实 践 中 存 在 应 用 性 低, 标 准 模 糊, 分 类 重 叠 等 问 题 因 此 DSM-5 针 对 这 些 问 题 将 其 修 改 为 躯 体 症 状 障 碍, 删 去 医 学 无 法 解 释 症 状 的 要 求, 增 加 心 理 标 准, 合 并 和 简 化 亚 型, 以 改 善 该 诊 断 标 准 的 临 床 应 用 本 文 分 析 了 DSM-5 躯 体 症 状 障 碍 修 订 的 主 要 内 容 和 原 因, 并 讨 论 了 新 标 准 在 未 来 面 临 的 问 题 和 可 能 的 进 展 躯 体 形 式 障 碍 ; 躯 体 症 状 障 碍 ; DSM- Ⅳ; DSM-5; 精 神 障 碍 诊 断 R395 1 引 言 (somatoform disorder) (somatization), (hypochondriasis) (medical unexplained symptoms, MUS) 1980, (American Psychiatric Association, APA) (Diagnostic and Statistical Manual of Mental Disorders, DSM- Ⅲ),, DSM DSM-Ⅳ DSM-Ⅲ, (International : 2013-05-27 * 09BSH044 :, E-mail: wangxj @nankai.edu.cn Classification of Diseases, ICD), (Chinese Classification of Mental Disorders CCMD) DSM-Ⅳ-TR (2000),, (conversion disorders) (body dysmorphic disorder), DSM-Ⅲ,,, DSM DSM ;,, DSM DSM-5( DSM- Ⅴ) (somatic symptom disorders) 2 DSM-Ⅳ 躯 体 形 式 障 碍 诊 断 标 准 的 问 题 及 缺 陷 DSM-Ⅳ,,, 1967
1968 21 DSM-5, (APA, 2011) 2.1 临 床 应 用 性 较 低 DSM-Ⅳ Creed Barsky (2004) 10, DSM-Ⅳ 0.03% 0.84%, 0.4% APA, DSM-Ⅳ APA 2000, 0.2% 2%, 0.2% (Koopman, Gill, & Kazdin, 2000), APA, (Baumeister & Härter, 2007), DSM-Ⅳ, ICD-10, (Simon & Gureje, 1999) DSM-Ⅳ, (undifferentiated somatoform disorder) (somatoform disorder NOS) (Kuwabara et al., 2007), 119, DSM-Ⅳ 1%, DSM-Ⅳ 79% (Lynch, McGrady, Nagel, & Zsembik, 1999) DSM-Ⅳ,, (Schulte & Petermann, 2011) DSM, DSM (Mangelli et al., 2009; Fink & Schröder, 2010), (Saxena, 2005; Creed, 2006) DSM-Ⅳ (Dimsdale, Patel, Xin, & Kleinman, 2007) DSM-Ⅳ,,,, 45%, 51%, 6%(Dimsdale, Sharma, & Sharpe, 2011),,,, ( ), (Rief & Isaac, 2007) 2.2 定 义 和 标 准 过 于 模 糊 DSM-Ⅳ, (Creed & Gureje, 2012)
11 : DSM-Ⅳ DSM-5 1969,,,,,,, (Kandel, 1999) (Browning, Fletcher, & Sharpe, 2011), DSM-Ⅳ,, (APA, 2011),,, (Rief & Rojas, 2007),, (Kroenke, 2007) ( ) (Ghanizadeh, & Firoozabadi, 2012),, ( ) 3 (Härter et al., 2007),, 2.3 诊 断 分 类 重 叠, (Hanel et al., 2009), ( ), (Rief & Isaac, 2007),,,,, 52%,, 38%, 2% ; (Dimsdale et al., 2011), 20% (Escobar et al., 1998), 5 (Fink et al., 2004),, ;
1970 21,,,, DSM-Ⅳ (),, (Mayou, Kirmayer, Simon, Kroenke, & Sharpe, 2005) 3 DSM-5 躯 体 症 状 障 碍 诊 断 标 准 的 修 订 DSM-Ⅳ, DSM DSM-5 2013 5 DSM-5,, 3.1 不 再 依 赖 医 学 无 法 解 释 症 状 DSM-5, DSM-Ⅳ, ;,,,, DSM-Ⅳ,,,,,,,,,, 3.2 相 关 的 心 理 症 状 标 准, (Martin, 2011; Jensen, Haahr, Frost, & Andersen, 2012) B (psychosocial),, DSM-5,,
11 : DSM-Ⅳ DSM-5 1971,,,,, (Rief, Mewes, Martin, Glaesmer, & Braehler, 2010; Martin & Rief, 2011),, (Martin, 2011), B,,, (Martin & Rief, 2011), DSM-5 (), DSM-5 DSM-Ⅳ, DSM-Ⅳ, DSM-5, B (Voigt et al., 2012; Wollburg, Voigt, Braukhaus, Herzog, & Löwe, 2013), 3.3 亚 型 分 类 的 合 并 和 简 化 DSM-Ⅳ,, (Rosmalen, Tak, & de Jonge, 2011),, DSM-5 (APA, 2011) (complex somatic symptom disorder) (simple somatic symptom disorder) DSM-Ⅳ,, (APA, 2012),, DSM-Ⅳ 30,, (APA, 2000) 6, (APA, 2012) (illness anxiety disorder), (Obsessive-compulsive disorder Spectrum), DSM-5
1972 21 DSM-Ⅳ,, (Stone et al., 2005), 3.4 新 修 订 引 发 的 争 议 DSM-5, APA, DSM-5, (Frances, 2013) DSM-5,,,,,, 15%, 26%, 7% (Frances, 2013) DSM-5,,,,, (Dimsdale, 2011),,, DSM-5 4 展 望 DSM-Ⅳ, DSM-5,, DSM-Ⅳ,,, DSM-Ⅳ DSM-5 (Dohrenwend & Skillings, 2009),, (cognitive-behavioral therapy, CBT) (Kroenke, 2007; Sumathipala, 2007),, (Allen, Escobar, Lehrer, Gara, & Woolfolk, 2002),,,,,,,, DSM
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Voigt, K., Wollburg, E., Weinmann, N., Herzog, A., Meyer, B., Langs, G., &Löwe, B. (2012). Predictive validity and
11 : DSM-Ⅳ DSM-5 1975 clinical utility of DSM-5 Somatic Symptom Disorder- Comparison with DSM-IV somatoform disorders and additional criteria for consideration. Journal of Psychosomatic Research, 73(5), 345 350. Wollburg, E., Voigt, K., Braukhaus, C., Herzog, A., & Löwe, B. (2013). Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5. Journal of Psychosomatic Research, 74, 18 24. From DSM-Ⅳ Somatoform Disorder to DSM-5 Somatic Symptom Disorder CHEN Zichen; WANG Xinjian (Department of Social Psychology, Nankai University, Tianjin 300071, China) Abstract: DSM- Ⅳ is one of the most widely used diagnostic criteria for the assessment of mental illness. However, in clinical practice, the DSM-Ⅳcriteria of somatoform disorders have several problems, which include poor applicability, imprecise standard, and overlapping classification. These aspects have been improved in the newer version of DSM, the DSM-5. The equivalent subcategory has been renamed as somatic symptom disorders in the DSM-5 criteria, with the language concerning medically unexplained symptoms removed, psychological criteria included, and subtypes combined or simplified. In this article, we analyze the major changes of DSM-5 somatic symptom disorders criteria. We also discussed a few potential problems with the new criteria and the possibilities to further develop the diagnosis criteria. Key words: somatoform disorder; somatic symptom disorders; DSM- Ⅳ; DSM-5; diagnosis of mental disorders