精神科診断において操作的診断基準は信頼性問題を解決したか

抄録

In this article, I examine why disagreements of diagnosis are likely to occur in psychiatric diagnosis. This problem (which I call the "reliability problem") raises the question of whether psychiatry might have real objectivity. If psychiatric doctors (specialists) give different diagnoses to the same patient, the patient would justly doubt the objectivity of the diagnoses. In addition, our expectation that psychiatry and its classification system relates to the objective world would be undermined, since the standard of classification seems to be liberally interpreted by each diagnostician. This problem has been addressed by the employment of so-called "operational diagnostic criteria." However, the following problems remain: (a) there are different operational criteria systems; (b) if several different operational criteria systems are at once applied to the same patients group, the proportions of patients with a disease vary depending on the criteria systems; and (c) because it is not shown that a particular criteria system has an advantage and validity over other criteria systems, there is no rationale for regimenting a particular criteria system. In other words, only one operational criteria system must be used uniformly by all diagnosticians before the reliability problem can be truly resolved, but this is not realistic at present. Since each diagnostician can choose any criteria system according to their preference, the reliability problem reoccurs regardless of the introduction of operational criteria. We need to continue to inquire into the reliability problem and the objectivity of psychiatry.