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Engrami
2009, vol. 31, br. 3-4, str. 5-18
jezik rada: srpski
vrsta rada: izvorni naučni članak

Savremeni koncept i dijagnostika poremećaja ličnosti
aMedicinski fakultet u Vašingtonu, Odsek za psihijatriju, Sent Luis, Misuri, SAD
bVA Medicinski centar u Sent Luisu, Misuri, SAD

e-adresa: svrakicd@psychiatry.wustl.edu

Sažetak

Suprotno očekivanjima, DSM (Diagnostic and Statistical Manual of Mental Disorder) kategorijalni pristup nije uspeo da poveća pouzdanost dijagnoze kod poremećaja ličnosti što je uticalo na kvalitet istraživanja u ovom polju, naročito na studije etiopatogeneze i lečenje. Da bi se u ovoj oblasti napredovalo, najvažnije je da buduće klasifikacije uvedu krupne revizije koncepta, dijagnoze i klasifikacije poremećaja ličnosti. Ovaj rad predlaže jednu takvu reviziju. Polazeći od nedavnog napretka u molekularnoj biologiji epigenetskih modulacija ponašanja, poremećaje ličnosti definišemo kao maladaptivne sindrome koji su se razvili kroz interakciju osobe i okoline. Maladaptaciju konceptualizujemo kao zakazivanje integrativnih funkcija ličnosti, npr., onih koje su zadužene za adaptivne procese kao sto su konceptualno učenje, sekundarne emocije, moralno rasuđivanje, socijabilnost itd. Ova nesposobnost adaptacije može biti izazvana snažnim biogenetskim dispozicijama ili patološkim uticajima sredine, ili oboma. Zbog toga, precizna dijagnoza poremećaja ličnosti zavisi od neurobioloških i adaptivnih patogenih faktora. Predlažemo dijagnostički algoritam poremećaja ličnosti u dva koraka: adaptivni procesi (npr. karakter) se koriste za dijagnostikovanje maladaptacije, dok se neurobiološki aspekti (npr. temperament) koriste za klasifikovanje kliničke prezentacije i za postavljanje diferencijalne dijagnoze. Predlažemo da se termin 'poremećaj ličnosti' zameni adekvatnijim terminom 'poremećaj adaptacije' zato što ovaj pojam preciznije raspodeljuje kauzalnost maladaptivnih sindroma (između ličnosti i okoline), i smanjuje stigmu koja je vezana za ovu dijagnozu. Prednosti u dijagnostici, istraživanju i lečenju koje nudi predloženo rešenje su detaljnije prodiskutovane.

Ključne reči

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