Störungen des Sozialverhaltens
Abstract
Störungen des Sozialverhaltens (DSM: Conduct Disorder) sind sowohl durch aggressive (z. B. körperliche Auseinandersetzungen) als auch nicht-aggressive Verhaltensmerkmale (z. B. Missachtung von Regeln, Schuleschwänzen) gekennzeichnet. Aussagen hinsichtlich Prognose und Verlauf oder Behandlungsempfehlungen sind aufgrund der Heterogenität der Verhaltenssymptomatik meist nicht für die Gesamtgruppe der Patienten gültig. Als mögliches prognostisches Kriterium wurde bisher im DSM-IV einzig die Subtypisierung nach dem Störungsbeginn berücksichtigt. Die Evidenzgrundlage hierfür ist jedoch nicht eindeutig, und seit Erscheinen des DSM-IV im Jahre 1994 hat sich die empirische Befundlage zu Störungen des Sozialverhaltens beträchtlich erweitert. Für die Neuauflage des DSM-5 wurde die Berücksichtigung weiterer Kriterien diskutiert, insbesondere persönlichkeitsspezifischer Risikofaktoren, mädchenspezifischer Merkmale oder dimensionaler Beurteilungskriterien bzw. die Ergänzung eines auf die Kindheit beschränkten Subtyps (Moffitt et al., 2008). Jedoch sind die wesentlichen diagnostischen Kriterien im DSM-5 gleichgeblieben; eine entscheidende Änderung ist die nun mögliche Klassifikation eines CD specifiers with limited prosocial emotions. Die Frage, inwieweit die im DSM-5 vorgenommenen Modifikationen hilfreich sind, um den Anforderungen einer psychiatrischen Klassifikation gerecht zu werden, soll in diesem Beitrag auf der Basis der vorliegenden Evidenzgrundlage diskutiert werden.
The diagnosis conduct disorder (CD) is characterized by aggressive (e.g., physical aggression) as well as nonaggressive symptoms (e.g., violation of rules, truancy). Conclusions regarding the course and prognosis, or recommendations for effective interventions, seem not to be equally valid for the whole patient group. DSM-IV-TR included subtyping age-of-onset as a prognostic criterion, even though the evidence base for subtyping from age of onset was rather sparse. The relevant literature on CD has grown substantially since the publication of DSM-IV-TR in 1994. For the new DSM-5 edition, some important issues were discussed, for example, consideration of personality traits, female-specific or dimensional criteria, and adding a childhood-limited subtype (Moffitt et al., 2008). Nevertheless, the diagnostic protocol for CD was not changed in the most parts in the new edition of the DSM-5; the addition of a CD specifier with limited emotions is the most relevant change. On the basis of the existing evidence base, this review discusses whether the modifications in DSM-5 are helpful for fulfilling the requirements of a reliable and valid psychiatric classification.
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