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Definition und Erfassung psychischer Störungen

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Definition and collation of psychiatric disorders

Current situation

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Zusammenfassung

Die Entwicklung von Klassifikationssystemen für psychische Störungen hat eine lange Tradition und wird von einer unverändert anhaltenden Diskussion zu grundlegenden Fragen begleitet. Dies betrifft v. a. die allgemeine Frage, wann überhaupt eine Störung vorliegt, sowie daran anschließend die Frage, welche und wie viele Störungen sinnvoll und notwendig sind. Im vorliegenden Beitrag wird ein Überblick über die mit den bisherigen Systemen Diagnostisches und Statistisches Handbuch Psychischer Störungen, 4. Aufl. (DSM-IV) und Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Ausgabe (ICD-10) verbundenen Paradigmen und Klassifikationsmethoden gegeben. Entgegen den ursprünglichen Erwartungen ist es nicht gelungen, auch nur eine der existierenden Diagnosen wissenschaftlich hinreichend zu validieren. Ebenso ist keine Alternative zum bisherigen deskriptiv-phänomenologischen Ansatz in Sicht. Die bevorstehenden Revisionen DSM-5 und ICD-11 werden keine konzeptuellen Neuerungen bringen, sondern lediglich einige neue Diagnosen einführen und die Kriterien einiger anderer Diagnosen modifizieren. Am Beispiel der Entwicklung von DSM-5 werden sowohl grundlegende Überlegungen als auch ausgewählte bevorstehende Änderungen kritisch diskutiert. Zudem werden Vorschläge für eine rationalere Entwicklung von Klassifikationssystemen vorgestellt.

Abstract

The development of classification systems for psychiatric disorders has a long tradition and is accompanied by a continuous discussion concerning fundamental questions. These concern general aspects of classification, such as the definition of a disorder and how many disorders are useful and necessary. This paper gives an overview of the current systems the diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV) and the statistical classification of diseases and related health problems, 10th revision (ICD-10) and the paradigms of classification. Contrary to expectations successful validation of any of the existing diagnoses in a sufficient way was not possible. Similarly no alternative to the currently used descriptive-phenomenological approach is in sight. The forthcoming revision of DSM-5 and ICD-11 will bring no conceptual innovations, only some new disorders will be introduced and the criteria of some disorders will be modified. Using the development of DSM-5 general considerations as well as expected specific changes will be critically discussed. Furthermore, examples for a more rational development of classification systems will be presented.

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  1. Universitäre Psychiatrische Kliniken (UPK) Basel, Wilhelm Kleinstr. 27, 4012, Basel, Schweiz

    Rolf-Dieter Stieglitz

  2. Psychologisches Institut, Abteilung Klinische Psychologie und Psychotherapie, Universität Mainz, Wallstr. 3, 55122, Mainz, Deutschland

    Wolfgang Hiller

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Correspondence to Rolf-Dieter Stieglitz or Wolfgang Hiller.

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Stieglitz, RD., Hiller, W. Definition und Erfassung psychischer Störungen. Psychotherapeut 58, 237–248 (2013). https://doi.org/10.1007/s00278-013-0978-4

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