人格違常
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人格違常，或稱人格疾患、人格異常、人格異常疾患，英文：Personality Disorder。是精神疾病中，對於一群特定擁有長期而僵化思想及行為病患的分類。這類疾患常可因其人格和行為的問題而導致社會功能的障礙。
人格違常是據美國精神科醫學會所定，這類疾患的表現是跨文化和國界的。它們被定義成發病期至少要能追溯到成長期早期或更早。要能符合人格違常診斷的最低標準是疾患本身必須已干擾到個人、社會、或職業功能。
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[编辑] 診斷標準
根據美國精神科醫學會出版的『精神疾患診斷及統計手冊』(Diagnostic and Statistical Manual of Mental Disorders，簡稱DSM，目前出版至第四版)，人格違常在精神科診斷五軸中，被置於第二軸的診斷描述。
[编辑] 人格違常的整體診斷標準
為了確診人格違常，必須有以下幾個標準： 一、行為與其個人所處的社會文化明顯不同，且至少有下列兩種以上異於常人的表現：
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- 認知功能：對自己、他人、和事件的認知
- 情感功能（情感的表現方式、強度、變化度、和情感表的合宜性)
- 人際關係
- 對於衝動的控制
二、表現的情形長期固定不變。 三、其表現的狀況足以影響到其個人、社會、職業等正常的功能。 四、發病最早可追溯到青春期或早年成年期。 五、其疾患不是由其它精神疾病所造成。 六、其疾患不是由物質(如毒品）或其他身體疾病(如頭部外傷)所造成。
十八岁以下符合以上标准者通常不被诊断为有人格違常,但可能会被诊断为其他类型的违常症.18岁以下者不会被诊断患有反社會人格違常.
[编辑] 人格違常的分類列表
根據精神疾患診斷及統計手冊第四版，人格疾患可分為三大群：
A群 (奇怪型或異常型疾患)
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- 妄想型人格違常
- 類精神分裂型人格違常
- 分裂病型人格違常
B群 (戲劇型或情感型疾患)
C群 (焦慮型或恐懼型疾患)
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- 畏懼型人格違常
- 依賴型人格違常
- 強迫型人格違常
參見多重人格疾患
The DSM-IV also contains a category for behavioural patterns that do not match these ten disorders, but nevertheless have the characteristics of a personality disorder; this category is labeled Personality Disorder NOS (Not Otherwise Specified). The previous version of the DSM also contained the Passive-Aggressive Personality Disorder and the Self-Defeating Personality Disorder. Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-Aggressive Personality Disorder and Depressive personality disorder were placed in an appendix of DSM-IV for research purposes.
[编辑] 目前的思考方向與批判
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The DSM attempts to represent a consensus view of the members of the American Psychiatric Association. However, more so than in other parts of the DSM, the classification of Axis II personality disorders—deeply ingrained, maladaptive, lifelong behaviour patterns—has come under sustained and serious criticism from its inception in 1952[來源請求]. The DSM adopts a categorical approach, assuming that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). This is doubted by many[來源請求]. The polythetic form of the DSM's Diagnostic Criteria—only a subset of the criteria is adequate grounds for a diagnosis—generates diagnostic heterogeneity. In other words, people diagnosed with the same personality disorder may share only one criterion or none. Some people think that this is unacceptable[來源請求].
The DSM has arbitrarily separated off Axes I and II so that it:
- "... ensures that consideration will be given to the possible presence of Personality Disorders and Mental Retardation that might otherwise be overlooked when attention is directed to the usually more florid Axis I disorders. The coding of Personality Disorders on Axis II should not be taken to imply that their pathogenesis or range of appropriate treatment is fundamentally different from that of the disorders coded on Axis I.[來源請求]"
However, the DSM does not contain an explanation of the relationship between Axis II (personality) and Axis I (non-personality) disorders, or the way in which chronic childhood and developmental problems interact with personality disorders. It is possible that the arbitrary separation of Axes I and II, although well intended, has created the wide spread false impression that these are fundamentally and possibly even biologically different types of illnesses[來源請求]. This has contributed to the stigmatization of Axis II disorders in the mental health field[來源請求].
Christine Warner, a neuroscientist, thinks that the differential diagnoses are vague and the personality disorders are insufficiently demarcated[來源請求]. This overlap is addressed in the DSM by grouping the personality disorders into three clusters, which contain similar disorders. The result of the overlap is excessive comorbidity: people often receive multiple Axis II diagnoses[來源請求]. This casts doubt on the assumption that the diagnostic categories correspond to independent disorders[來源請求]. The necessity of the "not otherwise specified" basket category can also be seen as an indication of poor construct validity[來源請求]; the current diagnostic categories are apparently insufficient to categorize all people with personality disorders.
The distinction made between "normal" and "disordered" personalities is also rejected by some[來源請求]. The "diagnostic thresholds" between normal and abnormal are either absent or weakly supported. The judgment whether a behavioural pattern is normal or disordered is also highly subjective[來源請求]. The DSM contains little discussion of what distinguishes personality styles (personality), from personality disorders and much is left to clinical judgment.
Cultural bias is evident in certain disorders such as Schizoid personality disorder, Antisocial personality disorder, and Schizotypal personality disorder[來源請求]. Also, diagnosis of some disorders may be vulnerable to bias because of gender role expectations.1
The emergence of dimensional alternatives to the categorical approach is acknowledged in the DSM-IV-TR itself:
- "An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another" (p.689)
Despite considering all of the above, the DSM continues for the present to prefer the use of a categorical approach over a dimensional approach which is seen as, "less useful than categorical systems in clinical practice and in stimulating research."
In the mental health field, the category of personality disorder has become a pejorative concept[來源請求]. Of all of the personality disorder categories, Borderline Personality Disorder, and Antisocial Personality Disorder, have become most negatively identified categories[來源請求]. Some clinicians refuse even to specify which Axis II category may be present, using instead the evasion, "Diagnosis Deferred"[來源請求]. Personality disorder symptoms, as with all mental disorders, can vary markedly over time and become much more acute during times of stress in an individual's life.
The following issues, long neglected in the DSM, are likely to be addressed in future editions as well as in current research:
- Development of disorders over time
- Genetic and biological underpinnings of personality disorders
- Development of personality psychopathology during childhood and its emergence in adolescence
- Interactions between physical health and disease and personality disorders
- Effectiveness of various treatments (talk therapies as well as psychopharmacology)
[编辑] 建議閱讀書籍
- 米農．提多 精神疾患診斷及統計手冊中的人格違常 - 第二版， 1995年出版 ISBN 0-471-01186-X
