ImportanceDSM criteria are polythetic, allowing for heterogeneity of symptoms among individuals with the same disorder. In empirical research, most combinations were not found or only rarely found, prompting criticism of this heterogeneity.ObjectiveTo elaborate how symptom-based definitions and assessments contribute to a distinct probability pattern for the occurrence of symptom combinations.Design, Setting, and ParticipantsThis cross-sectional study involved a theoretical argument, simulation, and secondary data analysis of 4 preexisting datasets, each consisting of symptoms from 1 of the following syndromes: posttraumatic stress disorder, depression, schizophrenia, and anxiety. Data were obtained from various sources, including the National Institute of Mental Health Data Archive and Department of Veteran Affairs. A total of 155 474 participants were included (individual studies were 3930 to 63 742 individuals in size). Data were analyzed between July 2021 and January 2024.ExposureFor each participant, the presence or absence of each assessed symptom and their combination was determined. The number of all combinations and their individual frequencies were assessed.Main Outcome and MeasureProbability or frequency of unique symptom combinations and their distribution.ResultsAmong the 155 474 participants, the mean (SD) age was 47.5 (14.8) years; 33 933 (21.8%) self-identified as female and 121 541 (78.2%) as male. Because of the interrelation between symptoms, some symptom combinations were significantly more likely than others. The distribution of the combinations’ probability was heavily skewed with most combinations having a very low probability. Across all 4 empirical samples, the 1% most common combinations were prevalent in a total of 33.1% to 78.6% of the corresponding sample. At the same time, many combinations (ranging from 41.7% to 99.8%) were reported by less than 1% of the sample.Conclusions and RelevanceThis study found that within-disorder symptom heterogeneity followed a specific pattern consisting of few prevalent, prototypical combinations and numerous combinations with a very low probability of occurrence. Future discussions about the revision of diagnostic criteria should take this specific pattern into account by focusing not only on the absolute number of symptom combinations but also on their individual and cumulative probabilities. Findings from clinical populations using common diagnostic criteria may have limited generalizability to the large group of individuals with a low-probability symptom combination.

中文翻译：

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揭开精神障碍演讲的结构


重要性DSM 标准是多元的，允许患有相同疾病的个体之间的症状存在异质性。在实证研究中，大多数组合没有被发现或很少被发现，从而引发了对这种异质性的批评。目的阐述基于症状的定义和评估如何有助于形成症状组合发生的独特概率模式。设计、设置和参与者这个交叉研究分段研究涉及 4 个预先存在的数据集的理论论证、模拟和二次数据分析，每个数据集包含以下综合征之一的症状：创伤后应激障碍、抑郁症、精神分裂症和焦虑症。数据来自各种来源，包括国家心理健康研究所数据档案馆和退伍军人事务部。总共纳入了 155 474 名参与者（个别研究的规模为 3930 至 63 742 人）。对 2021 年 7 月至 2024 年 1 月期间的数据进行了分析。 暴露情况 对于每位参与者，确定每种评估症状是否存在及其组合。评估所有组合的数量及其个体频率。主要结果和测量独特症状组合的概率或频率及其分布。结果在 155 474 名参与者中，平均 (SD) 年龄为 47.5 (14.8) 岁； 33 933 人（21.8%）自认为是女性，121 541 人（78.2%）自认为是男性。由于症状之间存在相互关系，某些症状组合的可能性明显高于其他症状组合。组合概率的分布严重倾斜，大多数组合的概率非常低。在所有 4 个经验样本中，1% 最常见的组合总共占 33.1% 至 78%。相应样本的6%。同时，不到 1% 的样本报告了许多组合（范围从 41.7% 到 99.8%）。结论和相关性这项研究发现，疾病内症状异质性遵循一种特定模式，由少数普遍的、典型的组合和出现概率极低的多种组合。未来有关诊断标准修订的讨论应考虑到这种特定模式，不仅关注症状组合的绝对数量，而且还关注其个体和累积概率。使用通用诊断标准从临床人群中得出的结果对于具有低概率症状组合的一大群个体来说可能具有有限的普遍性。