精神醫學診斷之變遷

Changes to the Psychiatric Diagnosis Protocol

最新版的精神疾病診斷準則（diagnostic and statistical manual-five edition，DSM-V）前幾個月由美國精神醫學學會正式出版，雖中文翻譯版尚未出版，但這最新的版本仍然引起盼望多年的研究者與臨床工作者許多的討論與爭議。因為不論臨床實用如何，似乎都與研究所需，有一段距離；研究者強調研究工具的準確性，但臨床工作者著重於方便與實用。精神疾病診斷準則的發展源於第二次世界大戰後，美國有鑑於戰場出現戰鬥衰竭症及往後的退伍軍人之創傷症候群，催生了精神疾病診斷分類的發展。自1951年至今已經過數次改版，也已被學界及臨床廣泛接受與使用，美國的保險公司也接受以此診斷所請領的保險給付。隨著最新版（DSM-V）的出刊，勢必使臨床工作者與研究者面臨新的適應。本文將從此準則的緣起，對其演進歷程進行回顧與評論。

The newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has just been published. The DSM is an essential tool for mental health professionals and clinicians to diagnose patient conditions and conduct post-diagnosis communications with patients. Further, hospitals, clinics, and insurance companies in the U.S. generally require a DSM diagnosis for all patients treated. The DSM may be used in clinical settings as well as in research settings for patient categorization purposes. Studies on specific disorders often recruit patients based on symptoms criteria listed in the DSM. However, the latest version of the DSM has generated controversy due to various issues and caused disappointment among some researchers and clinicians. In this paper, the authors conduct a comprehensive review of the development of the DSM.