8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

1/12

Hjtrhvostg g Nuobbhrkl Uhjcuhbhs, psoquogtrg y

hjsgyostg

"Pbl ujg flrkg ch vocg hj bl `lkj phrkothjhs`gpgr g bgs koshrogs chb ojcovocugboskl lcoskojuor bgs phjgs `ugjcl bg trgnhcog jlsgb`gjzg.

Po kh phrkoth, cihkh ojo`ogr bg `ljvhrsg`oj `lj gbnujgs

chfojo`oljhs, `lj gbnujgs chbokotg`oljhs `lj`hptugbhs. Wutopl ch hjfhrkhcgchs khjtgbhs trgtg bg psoquogtrg!

Hj gbnujg l`gsoj ah kgjhigcl bg khtflrg ch quh bg psoquogtrg `lkl @l`ah Hs`leg ch bg

khco`ojg sl`ogb, `lkl pr`to`g ch `uocgcls quh rh`lnh tlcls bls kgbhstgrhs quh jl `gehj hj bgs

`gthnlrgs `ohjtfo`l- jgturgbhs ch bg khco`ojg l bls rh`ursls sl`ogbhs. Bg khco`ojg lfrh`h

chkgnno`gkhjth ujg chfojo`oj ch sgbuc `lkl uj hstgcl ch eohjhstgr rhgbo!g`oj fso`l"

psquo`g# pgrg tlcg bg plebg`oj .@lkl hs le$ol quh $o$okls hj ujg sl`ohcgc bbhjg ch sufrokohjtl

kgbhstgr jl rhpgrgebhs plr trgtgkohjtls k%co`ls jo gucgs sl`ogbhs, `ugjcl uj clblr l ujg quhig

jl tohjh uj suestrgtl gjgtko`l `bjo`l chklstrgebh l hs okplsoebh ch hj`ugcrgr hj bgs phcgnlngs

sl`ogbhs sh bh htoquhtg `lkl hjfhrkhcgc psoquotro`g sh bh trgtg `lj gjsolbto`ls gjtochprhso$ls

quh hfh`to$gkhjth g`gbbgj hb clblr. &lcl hbbl pgrg jl `ljfhsgr bg okplthj`og chb bbgkgcl hstgcl chb

eohjhstgr pgrg lfrh`hr ujg $ocg euhjg . Hb jo'l jl hcu`gebh hj bg hs`uhbg g`geg hj hb psoquogtrg . Hb

gkg ch `gsg quhio`g ch clblrhs g bls quh jl sh bh hj`uhjtrg `gusg fso`g hb psoquogtrg bg htoquhtg ch

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

2/12

slkgto!gclrg bh cg gjsolbto`ls. Hb `lkhr`ogb quh jl cuhrkh geusg chb gb`lalb ch juh$l

gjsolbto`ls. &lcl `lj tgb ch jl `uhstoljgr bg hs`uhbg, hb alngr l hb `lkhr`ol `lkl fl`ls ch

gbohjg`oj kgbg $ocg quh ag quh trgjsflrkgr l chstruor.

(h ga quh bg prg`to`g psoquotro`g shg ujg pr`to`g ku prhthj`olsg) lfrh`h khilrgs pgrg tlcg `bgsh

ch kgbhs chsch buhnl prlkhsgs quh buhnl jl puhch `ukpbor. @lkl hb *bsgkl ch +ohrgers bls

psoquogtrgs lfrh`hj rhkhcols pgrg tlcg `bgsh ch sotug`oljhs) corh``oj chb cuhbl pgrg bgs `gtstrlfhsl bg kuhrth ch gbnj shr quhrocl, hjfrhjtgkohjtl gb hstr%s bgelrgb, clblr ch hjfhrkhcgchs rhgbhs

phrl ch `gusg chs`ljl`ocg `lkl bg hsquo!lfrhjog l bls trgstlrjls gfh`to$ls. &lcl g`geg hj uj tltuk

rh$lbutuk bbgkgcl psoquogtro!g`oj ch bg $ocg `ltocogjg. (h ga quh bg sgbg ch hsphrg ch uj

psoquogtrg shg uj bungr sojnubgr cljch `lhosthj chsch kgbhstgrhs egjgbhs sh`ujcgrols g bg $ocg

`ltocogjg `lj bls sufrokohjtls ks gtrl`hs ch bgs pso`lsos l bgs nrgjchs chprhsoljhs quh thrkojgj hj

hb suo`ocol. grg tlcls tohjh hb psoquogtrg ujg pgbgerg `lkl uj `urg l ujg pgstobbg `lkl uj k%co`l l

ujg rhageobotg`oj `lkl uj kgsgiostg

" qu rhbg`oj, so h#ostohrg, l$shrvg usthc hjtrh bg psoquogtrg y bg pso`lblng!

Bls cls nrhkols `lkpothj hj lfrh`hr rhkhcols quh psoquogtro!gj l pso`lblno!gj bg $ocg `ltocogjg/kegs prlfhsoljhs sh prlpljhj `lkl rhkhcols pgrg tlcls hsls kgbhstgrhs quh $gj chb jg`okohjtl

g bg kuhrth. Bg nhjth ag socl chsplshcg ch sus sgehrhs `lkujhs pgrg `rogr aoils, pgrg hb shl, pgrg

hj$hih`hr, pgrg bu`agr `ljtrg bg hpbltg`oj bgelrgb jh`hsotg t%`jo`ls quh prl$ostls ch sgehrhs pso

bh hjsh'hj g $o$or. so`lphcgnlnls pgrg `rogr aoils sgjls khjtgbkhjth, shblnls pgrg `lj`heorbls,

pso`blnls pgrg ag`hr cuhbl plr bg kuhrth ch bls chucls, nhrljtlpso`blnls pgrg hj$hih`hr

sgbucgebhkhjth jhurlpsoquogtrgs `ljtrg hb kleeojn.

Bls pso`blnls bokotgj hsh hjsh'gr g $o$or, bokotgj hstgs `urgs ch bg $ocg g pgbgergs bls psoquogtrgs

lfrh`hj gchks pgstobbgs quh ag`hj costgj`ogrsh g bls suihtls ch bg sotug`oj oj$osoebh `lj hbbl g

tlbhrgr khilr hb clblr $otgb . /kels lfrh`hj bl quh jl puhchj cgr) rhkhcols t%`jo`ls pgrg rhslb$hr

sufrokohjtls soj rlkphr bls kgr`ls ch bg sotug`oj quh nhjhrg hsls clblrhs quh jl slj ltrls quh

ojco$ocugboskl l hb khr`gcl. Bg bu`ag plr gthjchr g bgs plebg`oljhs hkhrnhjths quh eus`gj gkl

psoquogtro!gclr hjtrh gkels nrhkols hs pgt%to`g plr pgrth ch bls pso`blnls quh pochj ojthr$hjor hj

bls `hjtrls ch sgbuc `lj grnukhjtls ku `hr`gjls g bg gjtopsoqugotrg ch bls g'ls =7 "bg

hjfhrkhcgc khjtgb jl hs ujg hjfhrkhcgc `lkl bgs ltrgs gforkgj `lj iusto`og - phrl gforkgjcl quh

hs hb nrhkol pso`lbno`l `lj sus $grogcgs hs`uhbgs jl bgs rhchs plpubgrhs quohj puhchj rlkphr

hsg kgbgrog uregjg quh al `ljstotuhj bgs quhigs hj`ugcrgebhs hj bl pso`lbno`l l psoquotro`l.

Hjtlj`hs, psoquogtro%gr y pso`lblno%gr slj, shn&j usthc, tgrhgs kuy pr#okgs.

Hfh`to$gkhjth. Hj hb shjtocl sh'gbgcl ch psoquogtro!gr ch pso`lblno!gr, slj tgrhgs sokobgrhs. 5l shtrgtg ch sustotuor ujg pr`to`g psoquotro`g plr ujg pso`lbno`g sojl ch sgborsh ch gkegs rhchs quh

bokotgj bls gjbosos slbu`oljhs plpubgrhs gb hnlskl gb `gb`ubl gfh`to$l quh al clkojg bg

ochlblng plpubgr quh psoquogtrgs pso`blnls rhfuhr!gj `lkl gpgrgtls chb hstgcl quh slj. /jth

uj cuhbl l uj chspocl gkels cos`ursls rh`urrhj g khtflrgs h`ljlkostgs pgrg flrkubgr sus

trgtgkohjtls) chsoj$hrtor gfh`tls chb kuhrtl l hb trgegil phrcocl, $lb$hr g oj$hrtorbls. @ugbquohr

sotug`oj sh hjkgr`g plr gkels nrhkols hj bgs ls`urgs gnugs chb `gb`ubl hnlstg quh ch`g 0gr.

5l `ljl!`l g jgcoh quh agg ocl gb pso`blnl bh agg prhhs`rotl bg bu`ag slbocgrog `ljtrg sus

kgbhs sojl `uocgr ch s hj hb kgr`l ojtokostg. 5gcoh quh jl agg ocl jl bh aggj co`al quh %b jl

puhch grrhnbgr hb kujcl jo tohjh `ubpg ch sus chsgrrhnbls quh sh gfgjh gb `grph cohk. (h ah`al

bhhr uj kgjugb ch gutl`uocgcl hs ujg oj`otg`oj gb hnlskl ku`als ch bls kgjugbhs pgrg kuihrhs

ujg gut%jto`g gnrhsoj g shjtokohjtls gbtruostgs) gprhjchr g ch`or jl, jl gkgr chkgsogcl, `gb`ubgreohj hb ojthr`gkeol gfh`to$l pgrg jl sgbor chfrgucgcgs. Hj foj, ujg hsph`oh ch euhj oj$hrslr jl sbl

hj bg elbsg sojl hj bg `gsg l bg `gkg .

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

3/12

(hpsoquogtro!gr l chpso`lblno!gr bg $ocg `ltocogjg supljh rh`uphrgr uj sgehr `lkj quh gjths thjg

bg kglrg ch bg nhjth pgrg nhstoljgr bgs sotug`oljhs ch sufrokohjtl l `ljfbo`tl soj rh`urror g ujls

t%`jo`gs pso l ujg pgstobbgs `lj cuclsg l h`hso$g hfo`g`og 3bgs pgstobbgs psoquotro`gs slj g $h`hs

chkgsogcl hfo`g`hs phrkothj tlbhrgr sotug`oljhs ojtlbhrgebhs gclrkh`ohjcl bls shjtokohjtls quh

phrkothj `gkeogrbgs8. grg hs`u`agr phjgs l g`ljshigr `lj pruchj`og `ugbquohrg ch juhstrl hjtlrjl

sor$h khjls uj prlfhsoljgb pso quh jl `lkpgrth $gblrhs jo shjtokohjtls plr hbbl bls hjkgr`grg hjsosthkgs ochlbno`ls ch bg hs`uhbg g bg quh phrthjh!`g.

'g trgco`oj pso`lgjgbto`g (g chigcl su (uhbbg hj bg psoquogtrg g`tugb!

Bg psoquogtrg g`tugb hst clkojgcg plr `bgsofo`g`oljhs prl`hchjths ch bg ku plchrlsg /sl`og`oj

ch soquogtrgs /khro`gjls. 6g`h ujg c%`gcg okpusohrlj ujg `bgsofo`g`oj ch bgs hjfhrkhcgchs

khjtgbhs bbgkgcg (>0 111 quh h`bu `ugbquohr thrkojl pso`lgjgbto`l `lkl jhurlsos l aosthrog.

>h prhthjco `lj hbbl ujg `bgsofo`g`oj hkpro`g gthro`g ch bls trgstlrjls khjtgbhs quh supusl hj

bg pr`to`g hb quh bls psoquogtrgs chigshj ch phjsgr l ojthrprhtgr bg rhbg`oj ch bls sjtlkgs

psoquotro`ls `lj bg eolnrgfg ch sus pg`ohjths, pgrg eus`gr sonjls leihto$ls ch hjfhrkhcgchs

trgtgr bgs hjfhrkhcgchs `lj prltl`lbls ch `ljshjsl blnrgcls plr $ltg`oljhs chkl`rto`gs hj bls`ljnrhsls psoquotro ls. ?jg ch bgs rhbg`oljhs frhucogjgs ks trgco`oljgbhs bgs jhurlsos slj

oj$hrsoljhs ch bgs phr$hrsoljhs shugbhs# chsgpgrh`h ch bg (>0111 jl plr jojnj chegth thro`l

sojl `ugjcl hj hsgs $ltg`oljhs chsgpgrh`h bg phr$hrsoj `lkl `gthnlrg njlshlbno`g soj ks

hpbo`g`oljhs quh hb %otl chb `lbh`to$l ng hj blnrgr $ltls .

Hj hb fljcl bg (>0111 jg`o plr bg okplthj`og ch bg psoquogtrg l bg pso`lblng pgrg cognjlsto`gr

`lj prh`osoj. ?jls oj$hstongclrhs fuhrlj ojnrhsgcls `lkl hjfhrkls bls psoquogtrgs fuhrlj

oj`gpg`hs ch chth`tgr bg sokubg`oj. Hb alrrlr ch bls g'ls =7 hj bg g`gchkog psoquotro`g hs quh, gb

jl plchr ochjtofo`gr sokubgclrhs l jl pljhrsh ch g`uhrcl hj bgs phrotg`oljhs gjth bls iu!ngcls pgrg

egigs bgelrgbhs, bg gckojostrg`oj h`buhsh g bl psoquotro`l chb `gkpl k%co`l l chb pgnl ch bgs

ku plchrlsgs `lkpg'gs ch shnurl gkhro`gjgs. (h ah`al gbnujgs chfojo oljhs hj bg (>0

chphjchj ch uj pg`tl `lj hsgs `lkpg'gs pgrg quh jl hkpoh`hj g pgngr shnurls k%co`ls g bls

hsquo!lfr%jo`ls gjths ch 9 khshs quh sh honh pgrg hb cognjsto`l ch hstg hjfhrkhcgc. Bg $lbujtgc

ch shr hkpro`ls gthro ls egrro tlcg bg hposthklblng ch bg slsph`ag# quh +rhuc ageg

ojtrlcu`ocl pgrg ojthrprhtgr bls sjtlkgs psoquotro`ls cgr shjtocl g bg hjfhrkhcgc, pgrg rhbg`oljgr

hb sufrokohjtl psoquotro`l `lj bls plchrhs fgkobogrhs quh hs`roegj bg $hrsoj `gjjo`g fgbsg ch bg

ojfgj`og.

6l bls sjtlkgs pso`lbno`ls -juhstrgs gjnustogs l chprhsoljhs- slj ujg hsph`oh ch hquo$gbhjths

ch ujls trgstlrjls ch bls jhurltrgskoslrhs quh gujquh jgcoh puhcg khcor sh supljhj klcofo`gebhs

`lj pso`lfrkg`ls l thrgpogs. (h ga quh +rhuc shg al uj `lkpbhtl chs`ljl`ocl pgrg bgs juh$gsnhjhrg`oljhs ch psoquogtrgs.

4 hsl pgrg jl agebgr ch bg o!quohrcg frhucogjg quh col okplrtgjths kgthrogbhs pgrg bgs rh$uhbtgs

`ljtrg hb kgjo`lkol bg ojstotu`oj tltgb ch bls g'ls =7 bgs rhsosthj`ogs gjtogutlrotgrogs gb

fgkobogroskl. Bl pso`lgjgbto`l ag quhcgcl plr hbbl `lkl ujg hs`uhbg `lj hs`gsg gpbo`g`oj hj bg

`bjo`g rhgb hj pgrth plr sus prlpols hrrlrhs slerh bg `hjtrgbocgc chb cojhrl ch bg `urg topl 3+rhuc

gfork quh so hb hjfhrkl jl pgng cojhrl gb thrgphutg hs pl`l prlegebh quh sh `urh `gso shnurl quh

jl gegjcljgr su thrgpog8. Bg gpbo`g`oj bothrgb ch hsg rhbg`oj ch khco`ojg boehrgb ch pgnl plr g`tl

k%co`l okpoco gb pso`lgjbosos okpbo`grsh hj uj klchbl sl`ogb hj cljch ojthnrgrsh. +ojgbkhjth bg

rhnrhsoj ch bls pso quh rhjuj`ogj g flrkgrsh `lj bg prlfujcocgc hb trgegil quh honh gprhjchr

pso`lgjbosos thrkojgj ch hjslkerh`hr hb futurl ch bgs pr`to`gs pso`lgjgbto`gs .

Bls gkhro`gjls co`hj quh hb pso`lgjbosos hs ltrg ch bgs rgrh!gs ch gros hb jkhrl ch pg`ohjths

trgtgcls plr gjgbostgs jl bbhng jo gb ujl plr kob ch bg plebg`oj psoquogtro!gcg hj juhstrl kujcl

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

4/12

Wu sonjofo` gquhbbg rh$hboj gjtopsoquo)tro`g ch bls g*ls shshjtg y shthjtg gb quh usthc

(g`g rhfhrhj`og! Hstly phjsgjcl hj +llpphr, hj gssgnbog,-

Hb kl$okohjtl ch soquogtrg (hkl`rto`g quh hj`geh! *gssgnbog rhprhshjt bg $lbujtgc ch cgr bg

$uhbtg gb slfoskg chb kgjo`lkol quh hbucg hb gjbosos chb hj`ohrrl hj bg n%jhsos ch bg nrgj bl`urg

Bl koskl quh hj bls !llbno`ls sh prlcu`h ujg `ljcu`tg gjokgb quh jl hs bg rhgb hj hb kgjo`lkolsh prlcu`g bl quh *gssgnbog bbgkgeg hb (lebh ch bg Hjfhrkhcgc 0hjtgb. Hb kgjo`lkol prlcu`g

ujg bl`urg quh jl hrg bg ch bls pg`ohjths sojl bg prlcu`ocg plr hb hstonkg bg prlfh`g gutl`ukpbocg

ch bg psoquogtrg ch bg %pl`g quh chs`roeg bg bl`urg `lkl phbonrlsg h orrh`uphrgebh. (h ga quh tlcl

hb sgehr prlcu`ocl plr bg leshr$g`oj ch bl`ls hj`hrrgcls, hs ch`o,r tlcg bg pso`lpgtlblng `bso`g

hrg uj shucl sgehr pgrh`ocl gb ch bg !llblng chb pgrquh ch fohrgs. @gthnlrgs psoquotro`gs `hjtrgbhs

`lkl bg hsquo!lfrhjog `gtgtjo`g chsgpgrh`ohrlj ch bls boerls `ugjcl chsgpgrh`h hb hj`ohrrl

kgjo`lkogb

4l trgegi% hj uj kgjo`lkol `hr gjl g 0gcroc cljch bls pg`ohjths hstgegj ojthrjgcls

cognjlsto`gcls hj pgehbbljhs sojtlkto`ls. 6geg pgehbbljhs ch $olbhjtls, oj`ljtojhjths, `rjo`ls

`hrrgcls, geohrtls, ht`. lr uj chrrukeh tu$okls quh rhpgrtor bls ojthrjgcls chb pgehbbj ch$olbhjtls plr hb rhstl chb kgjo`lkol bg `ljcu`tg $olbhjtg chi ch prlcu`orsh hj bls hjfhrkls quh

pgch`gj bg $olbhj`og. Bg $olbhj`og jl hrg plr hbbl gbnl prlcu`ocl plr hb `hrherl l bg hjfhrkhcgc ch

bls pg`ohjths sojl `rhgcl plr bg ojstotu`oj quh bls `rljofo`geg.

(hb kgjo`lkol, hb gjbosos egssgnbogjl sh hthjco g ltrgs ojstotu`oljhs tltgbhs `lkl hb hi%r`otl, bgs

fero`gs, bls ojthrjgcls hstucogjtobhs fuh ku prlcu`to$l pgrg bgs rh$uhbtgs ch kgl 92. (h

rhphjth bgs kgsgs hj bgs fero`gs chs`uerohrlj quh hb sufrokohjtl bgelrgb jl thjg quh $hr `lj su

trgegil rhgb l bg prlcu``oj, sojl `lj bgs cos`opbojgs quh okpljgj nhrhjths `gpgtg`hs. Bls

kl$okohjtls ch bg /utljlkg ;erhrg otgbogjg chehj ku`al g hsh gjbosos plstegssgnbogjl hj %b quh

bg fgero`g sh pgrh`h gb kgjo`lkol l hb `ugrthb hj fgbsofo`gr bgs $ocgs ch sus ojthrjgcls hj `rhgr ujg

$ocg clebh ch bg rhgb- plsoebh. (hstruor bls kurls ch hsgs ojstotu`oljhs fuh bg ehbbg `ljsonjg quh

sgbtl ch bls kgjo`lkols g bgs `r`hbhs, bgs fero`gs l bls `ugrthbhs. Bg hsphrgj!g ch chstruor hsh

gr`aopo%bgnl ch ojstotu`oljhs quh bokotgegj bg $ocg fuh hb btokl fgjtgskg ch bg boehrtgc quh l

`ljl`.

Hj `ugjtl g +llpphr...

@llpphr Bgojn ao`ohrlj ujls gjbosos ks ko`rlsl`ogbhs ch bg fgkobog `lkl ojstotu`oj

nhjhrgclrg ch pgtlblng khjtgb `lcofo`gjcl fonurgs `lkl bls pgcrhs hsquo!lfrhjnhjls l bgs thlrgs

chb clebh $j`ubl `lkl suestrgtl ch bg `lkujo`g`oj gutlrotgrog hjblquh`hclrg quh quhergeg bg

ochjtocgc chb suihtl `gso chsch hb jg`okohjtl .(h juh$l bg bl`urg hrg prhfgero`gcg chsch bg orrg`oljgbocgc ch bg gutlrocgc fgkobogr. @ugjcl sh

fgbsofo`g bg phr`hp`oj ch bgs jh`hsocgchs ojfgjtobhs ujg kgcrh gforkg sgehr quh su aoil tohjh

suh'l cheh orsh g bg `gkg gujquh hb jo'l cong jl thjhr suh'l sh hstg ojo`ogjcl hsh prl`hsl ch

p%rcocg ch sgehr jtokl quh hj su htrhkl `rhg bl`urg 3bg gutlrocgc bg lrchj ch $hth g bg `gkg sh

hjkgs`grg hj `ukpbor bgs fgbsgs jh`hsocgchs chb jo'l `lkl hb khr`gcl sgtosfgr tlcgs bgs fgbsgs

jh`hsocgchs chb gcubtl8. Hb cos`ursl chb pgcrh gpgrh`h hj hsls gjbosos `lkl hb h`l corh`tl ch bg $l!

chb gkl hstgtgb, kohjtrgs bg kgcrh hs ujg fonurg ks hjblquh`hclrg plr su pgphb gkeo$gbhjth hjtrh

bg oj`otg`oj g bg sukosoj bgs fgjtgsgs utpo`gs. Hstls gjbosos fuhrlj ku prlcu`to$ls pgrg hb

phjsgkohjtl gjtogutlrotgrol gjtofgkobogr `lj prlpuhstgs ch `lkujocgchs thrgp%uto`gs soj

thrgphutgs hj chshjkgs`grgr tlcgs bgs trgkpgs quh hb bhjnugih jlrkgb flrigcl hj bg ojtokocgc `rhg

hj bg hjgihjg`oj `ltocogjg. :hstoljgr bg hjsh'gj!g ch bls shjtokohjtls `lrrh`tls, ch `kl sh chehquhrhr quh `ljstotug ujg fuj`oj fgkobogr `hjtrgb, sgbt plr bls gorhs hj hsls g'ls nrg`ogs g bls

gjbosos ch Bgojn

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

5/12

Bg chrrltg ch tlcl hsh kl$okohjtl hs al ks quh h$ochjth, `ugjcl bgs fgkobogs ch hjfhrkls tohjhj

uj plchr nrgjch pochj trgtgkohjtls lebongtlrols l `hrrgcls pgrg sus aoils hj bg pr`to`g hstj

blnrgjcl bg $uhbtg g ujgs cos`opbojgs pgjpto`gs `hr`gjgs g jhl kgjo`lkols gb usl kgso$l ch

pso`lfrkg`ls ojh`tgebhs quoj`hjgbkhjth `lkl prlfobgos ch `ugbquohr `ljcu`tg $olbhjtg. @gcg

$h! quh ag uj g`tl $olbhjtl ch uj pg`ohjth psquo`l hb `bgklr plr hb hj`ohrrl jl `hsg bgs

kgbco`oljhs `ljtrg bg gjtopsoquogtrog tgkpl`l.

/forkgr quh gquhbbl jl fuh uj suh'l quh hfh`to$gkhjth bu`agr `ljtrg hb kgjo`lkol fuh bu`agr

`ljtrg hb lrchj l hb fgkobogroskl hs al, ks quh uj hihr`o`ol ch khklrog, ujg gforkg`oj ch bg

hsphrgj!g hj rherlths ch bg rg!j trgs su h`bopsh.

Hj bgs hjfhrkhcgchs khjtgbhs, bg (hrhj`og nhjto`g hs chthrkojgjth! jfbuyh, ch qu flrkg,

hb gk$ohjth sl`ogb, bg hstru`turg fgkobogr! /hphjch ch bgs hjfhrkhcgchs!

Bls `lj`hptls ch hjfhrkhcgc khjtgb hstj kgb chfojocls plr hbbl hs cof`ob ch `ljthstgr g bg

prhnujtg ch bgs ojfbuhj`ogs chb gkeohjth l bls nhjhs. Hj bls nrgjchs sjcrlkhs eoplbgrhs

hsquo!lfr%jo`ls bg ahrhj`og pgrh`h ojcucgebh phrl hs bg ahrhj`og ch ujg $ubjhrgeobocgc quh jl shpgrh`h gb klchbl chb chsphrtgclr eolbno`l prhpgrgcl pgrg quh surig bg hjfhrkhcgc g bg bhngcg gbg

puehrtgc.

Hb erlth pso`to`l bgs fgshs kgjog`lchprhso$gs prh`osgj ch uj chshj`gchjgjth ujg $h!

chshj`gchjgcg su h$lbu`oj chphjch ch `kl sh trgth sh prh$hjngj bgs rh`gcgs. >o sh bg

khco`gbg!g hj htrhkl l sh bg hj`ugcrg hj prlfh`g gutl `ukpbocg -bg bl`urg juj`g `urg- sh

trgjsflrkg hj uj prl`hsl oj$gbochjth quh ag`h suihtls chphjcohjths ch plr $ocg, quh jh`hsotgj

shnj bls prltl`lbls g`tugbhs $onobgj`og `ljtrlb phrhjjh soj jojnujg plsoeobocgc rhgb ch gbtg

k%co`g. 0%co`ls fgkobogs `loj`ochj quh gjth hb rohsnl ch rh`gcg hs prhfhroebh trgtgkohjtls

phrhjjhs.

lr hb `ljtrgrol quh sh bokoth hb trgtgkohjtl hb prljsto`l plsoto$l g hposlcols pso`to`ls `lj

phrsph`to$gs ch `urg, phrkoth $ocgs hj boehrtgc quh nhstoljhj `lj pruchj`og hsh rohsnl ojcucgebh ch

rh`gcg quh bls nhjhs prl$l`gj. :hstoljgr hsh rohsnl chsch bl gutlrotgrol bg prlfobgos chb plr so

g`gsl rh`gh quh tlkh jhurlb%pto`ls ch plr $ocg# l g`hptgr hb rohsnl #soj khco`gr plr so g`gsl#

chfojh al bgs plsturgs jhlkgjo`lkogbhs l boehrtgrogs frhjth g bgs nrgjchs pso`lsos .

Hb rhstl ch bls trgstlrjls psquo`ls -chprhsoljhs, gjnustogs, trgstlrjls ch phrsljgbocgc, kgbhstgrhs

plr hstr%s- slj fgbsgs hjfhrkhcgchs quh sh htoquhtgj `lkl tgbhs pgrg ojco$ocugbo!gr suihtls frnobhs

pgrg quh puhcgj shr trgtgcls `lj t%`jo`gs quh jl pljngj hj `uhstoj hb pgphb chshj`gchjgjth ch bg

kgbg $ocg uregjg quh hst hj bg egsh ch sus sufrokohjtls. 5o hb trgegil `lkl bl `ljl`hkls, jo bgs`gsgs ch $h`ojls quh grto`ubgj juhstrgs `oucgchs, jo bgs fgkobogs rhgbkhjth hosthjths slerh$o$orgj

soj bg tlkg kgso$g ch gjsolbto`ls quh phrkothj clrkor, bh$gjtgrsh gnugjtgrjls ujls g ltrls hj hsg

hsph`oh ch `blg`g slerhplebgcg hj quh $o$okls. Bls prl`hsls ch htoquhtgcl pso`lblno!g`oj ch

hsls kgbhstgrhs quh phrkothj shgj $o$ocls hj pro$gcl jl sh `lbh`to$o`hj `lkpbhtgj hb pgphb

gpg`onugclr costgj`ogclr quh phrkothj bgs `gthnlrgs psoquogtro!gjths bls pso`lfrkg`ls

/ fojgbhs ch

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

6/12

@lj`rhtgkhjth, shnj hb 54&, ujl ch bls psoquogtrgs forkgjths chb (>0 ageg hihr ocl ch

`ljsubtlr ch trh`h bgelrgtlrols cofhrhjths hj bls btokls `oj`l g'ls 3hjtrh hbbls, gbnujls ch plchr

tgj ojkhjsl, `gso ojgegr`gebh, `lkl Dhta fo!hr8. Hs gsK ?jg sotug`oj ch chphjchj`og l

suelrcojg`oj ch hsth lrchj, puhch gb`gj!gr hstg cokhjsojK &gkeo%j hj Hspg'gK

?j gjsolbto`l "hb blrg!hpgj, prlpohcgc ch ujl ch bls cls bgelrgtlrols quh khj`oljgs" hs hb

frkg`l ks $hjcocl hj Hspg'g plr hj`okg ch bg gsporojg l bls gjgbn%so`ls Hj nhjhrgb hj gphjgs

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

7/12

+gk$ol ch thr ol. =sthc (g sh*gbgcl rh`ohjthkhjth quh hb (h`(l ch quh hb 750 ch bg

pl$bg`oj l$rhrg gsturogjg gfh`tgcg plr rh`ljvhrsoljhs g`ucg (ly g bls +hjtrls ch Pgbuc

3hjtgb hihkpbofo`g uj chsgstrh8 6hb vohil lrnubbl chb prlbhtgrogcl quh 6sg$og quoj hrg> hst)

sohjcl su$stotuocl plr phrsljgbocgchs pgsovl chphjcohjths quh $us`gj hj bls 1pso? tuthbg,

pgstobbgs y `ljshils pgrg rh`ljcu`or su vocg shn&j uj rnokhj ch shrvocuk$rh vlbujtgrog>.

9lr qu (g$bg usthc ch shrvocuk$rh vlbujtgrog! Wu plcrgj (g`hr hjtlj`hs blstrg$gigclrhs4gs gfh`tgcls!

>o kh phrkots bg phquh'g nrlshrg, bl quh eus`gj hj sgbuc khjtgb bls trgegigclrhs gnleogcls sh

pgrh`h gb quh pgrg eus`grsh gklrhs sh $g ch putgs. /jth hb alrrlr rhgb ch bg $ocg `ltocogjg, tlcl hb

kujcl sufrh jh`hsotg quh gbnuohj bh hs`u`ah, gfh`tl, `ljshils pruchjths l oj`busl kokls quh

gbo$ohj hb alrrlr h`ljko`l. *us`grbl hj uj prlfhsoljgb quh `lerg chb hstgcl plr hsls khjhsthrhs,

jl `lkpgrth bgs rhgbocgchs chb trgegil l hb egrrol l puhch thjhr ujls $gblrhs tgj lpuhstls gb

`ljsubtgjth `lkl shr chb lpus cho 3ujg ch kos pg`ohjths chil ch or gb psoquogtrg chspu%s ch cls

g'ls, `ugjcl supl quh su thrgphutg jl hstgeg hj `ljsubtg plr or ch `g`hrg8 pgrh`h ujg `ljfusoj

$otgb ks quh `lkl gquhb elrrg`al eus`g bg bbg$h jl cljch bg ag phrcocl sojl cljch hb

gujtgkohjtl obukojg.

+rhjth g hsg gucg prlfhsoljgbo!gcg quh `lbljo!g bg $ocg chsch uj sgehr pl`l `rhebh 3ag kubtotuc

ch hs`uhbgs pso8, hb puhebl chehrg `lbh`to$o!gr su clblr g`ukubgr $gblr pgrg korgr ch frhjth bl quh

lfhrtg bg $ocg hj hb khr`gcl, soj hcub`lrgrbl `lj bg fgbsg prlkhsg ch quh `ugjcl bg `lsg $gg kgb

gbnj pso ch bg shnurocgc sl`ogb# kh gucgr gujquh l jl thjng rhchs slbocgrogs hj quh gplgrkh.

/prhjchr quh hb kgbhstgr jl chphjch ch su psoquh ojco$ocugb sojl ch bgs rhbg`oljhs ch hpbltg`oj

sukosoj gb okgnojgrol ch chshls quh jls ag`h $o$or plr hj`okg ch juhstrgs plsoeobocgchs `lj

klchbls ch `bgsh khcog hs bg gkgrng $hrcgc quh bg plebg`oj trgegigclrg sh johng g $hr. >gehr quh

so kh hj`ohrrl hj hb hnlskl bg esquhcg ch sgb$g`oj hj hb ojtokoskl `ugjcl hsg $ocg jtokg sh

kh chrrukeg , plr hihkpbl, sh kuhrh ko leihtl gklrlsl l pohrcl hb trgegil, jojnj prlfhsoljgb

kh puhch gucgr rhgbkhjth plrquh jojnj prlfhsoljgb puhch shjtor `ljkonl g suhbcl, puhch shr uj

prokhr pgsl hj hsg rhjuj`og g bgs fgbsgs prlkhsgs. >lbl chsch bgs $ohigs slbocgrocgchs, ch agebgr

`gcg kg'gjg `lj bls `lkpg'hrls sgbor g tlkgr socrg l $ojl trgs hb trgegil pgrg kgbch`or gb pgtrj

l `lkhjtgr bls g!grhs ch >gj khr`gcl `lj bg hsphrgj!g quh gbnj cg tlcl hsh sosthkg `gong, fuh

$o$oebh ujg `ltocogjocgc tgj curg `lkl bg chb trgegigclr fgerob trgco`oljgb. >bl bl g`lnhclr chb

egrrol, ch bls bungrhs cljch ujl hst hjtrh bls suls, sbl bls $j`ubls `lj bls `lkpg'hrls sus

fgkobogs ujg flrkg ch $ocg hj bl `lkj phrkothj hs`gpgr g bgs koshrogs chb ojco$ocugboskl l

coskojuor cobu%jclbgs hj bl `lbh`to$l bgs phjgs `ugjcl bg trgnhcog jls gb`gj!g.

>o `gcg ujl $g ch su `gsg gb trgegil, sh hj`ohrrg hj hb fgkobogroskl hj bls nrupls ch gfo`oljhs`lkujhs, hst `ljchjgcl g thjhr uj gbtl rohsnl ch thrkojgr hj hb psoquogtrg `lkl hb quh g`uch gb

bupgjgr g eus`gr gklrhs prlfhsoljgbhs

Hb prh`grogcl hj hb quh vovh ujg nrgj pgrth ch bls trg$gigclrhs hspg*lbhs, gut`tljls l jl,

hst) gfh`tgjcl g su sgbuc khjtgb! 2gy `ofrgs gb rhsph`tl! Ph (g$bg ch ujg hpochkog ch

chprhsoljhs quh gfh`tg gb 750 ch bg pl$bg`oj y (gy $grrogcgs l$rhrgs cljch hs k)s jlrkgb

(g$hr pgsgcl plr bgs `ljsubtgs ch sgbuc khjtgb quh jl (g$hr jh`hsotgcl gyucg psoquo)tro`g g

bl bgrnl ch bg vocg .

Bg koshrog sueihto$g quh bg $ocg hj prh`grol `rhg hs bg okplsoeobocgc ch `rhgr hsls $j`ubls shrhjls

ch bls quh agebgeg ks grroeg pgrg chs`roeor bg `ltocogjocgc ch bg `bgsh lerhrg trgco`oljgb. ?j jo'ltohjh uj $j`ubl shrhjl `ugjcl puhch iungr hj hb pgrquh soj korgr `ljtojugkhjth g su kgcrh plrquh

sgeh quh hbbg $g hstgr g gbb `ugjcl sh `gong. ?jl puhch grrohsngrsh hj bg $ocg shr uj g`to$ostg

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

8/12

sl`ogb so sgeh quh tohjh ujg rhc sl`ogb gkpbog quh `ugjcl bg chsnrg`og bh gb`gj`h $g g thjhr

slbocgrocgchs kbtopbhs. Hsls bg!ls slbocgrols, hsls $j`ubls shrhjls jh`hsotgj tohkpl trgco`oljhs

ch ochjtocgc. (hsch hb `lbhnol bls gjtonuls trgegigclrhs `lcofo`gegj sus nustls sus kgjhrgs gb

okgnojgrol ch `bgsh quh bls prlthng bls hjcurh`g chb kujcl alstob ch bls sh'lrotls) sgegj quh

bls khbojcrhs l bg chprhsoj jl hrgj pgrg hbbls, quh gb tgil sh oeg g sufror phrl quh bg $ocg plcg

phrkotorbhs ch$lb$hr nlbphs g hsh kujcl ch bg eurnuhsog so phrkgjh`gj iujtls. >oj tohkpl pgrg

hstgr iujtls soj `lnhr g `otg quh bgs $ohigs trgco`oljhs lerhrgs bhs prlplr`oljgj bls prh`grols hstjphrcocls) jo ochjtocgc `lbh`to$g, jo chfhjsgs ch `bgsh bhs prlthnhj. Bg ochlblng chb `grl, bg $ohig

gstu`og chb bg!grobbl pgrg eurbgr sg`gr bgs $hjtgigs quh puhch pgrh`h shr bg thjchj`og sueihto$g

prhfhrhjth hj hb prh`grogcl quh `lrrh `lkl puhch hjtrh gkls chsgbkgcls eus`gjcl `lergr chb pgrl

l bgs egigs k%co`gs hs bl quh sh $h ch juh$l chsch bgs `ljsubtgs ch sgbuc khjtgb.

Hb thrkojl chprhsoj hs uj `gij ch sgstrh quh quohrh ch`or kgb$o$or l oj`gpg`ocgc ch gutlnhstoljgr

bg $ocg soj gucgs prlfhsoljgbhs. /fh`tg g sh`tlrhs ch plebg`oj ks `lbljo!gcgs plr hb ojtokoskl)

kuihrhs, prh`grols soj rhchs sl`ogbhs sbocgs, $ohils soj `lkpg'g quh bgs agj phrcocl, i$hjhs

rhjhngcls ch su `bgsh gsporgjths g trhpgr sl`ogbkhjth. +rhjth g hbbls bg $ubjhrgeobocgc g bg

chprhsoj sh oj$ohrth `ugjcl hb tohkpl ch trgegil l bg lrngjo!g`oj ch g`to$ocgchs `rhg nrupls `lj

ochjtocgchs slbocgrogs quh sh supljhj puhchj curgr tlcg bg $ocg. +rhjth gb $lbujtgrogcl sl`ogb quh`rhg nrupls bonhrls quh bbgkg 6. *higr ch kgbls sgkgrotgjls bls $ohils sojco`gtls, bls nrupls

`lkujostgs, bgs `lkujocgchs rhbonolsgs, `rhgegj $j`ubls h ochjtocgchs sbocgs quh hjcurh`gj

hkplchrgegj# 3ag`gj shjtorsh cuh'ls ch s8 g sus kohkerls frhjth g bgs `rosos $otgbhs quh hb prlpol

tohkpl nhjhrg. >h ch`g gquhbbl ch uj `lkujostg juj`g hst slbl plrquh supljg quh `ugbquohr

trgegigclr plcg shr su gkonl quh bgs hcgchs chb alkerh -iu$hjtuc, kgcurh!, $hih!- thjgj ujls

rotugbhs tgj `hr`gjls g bl rhbonolsl quh ag`g quh oj`busl bg kuhrth fuhsh g`hptgcg `lkl uj pgsgr bg

`otg `lj bg aostlrog g bgs nhjhrg`oljhs $hjochrgs. >o hsg ochjtocgc sh bo`ug hb prh`grogcl jl phrkoth

hjbg!gr bg $ocg ojco$ocugb `lj hsls `lbh`to$ls hsgs trgco`oljhs bg `ltocogjocgc sh `lj$ohrth hj hsh

`uhjtl bbhjl ch ruocl furog `ljtgcl plr uj ocoltg quh f`obkhjth eus`g shjtocl-`ljsuhbl hj hb pso.

/ hsh shsnl `lnjoto$l ch eus`gr gucg fuhrg ch bls onugbhs, hj bls hphrtls, hj bg t%`jo`g hs bl quh

bbgkl prl`hsl ch shr$ocukerh $lbujtgrog quh jo soquohrg hs `ljsh`uhjth `lj bg ochlblng hnlstg quh

ag hbhnocl quh hjbg!g `lj hb prltltopl ch B!grl ch &lrkhs quh ah prlpuhstl bjhgs grroeg.

+kl `rhh usthc quh hst) gfh`tgjcl bg g`tugb `rosos, hstg `rosos `uyl fljcl jl g`g$gkls ch

hjtrhvhr, g bgs nhjths trg$gigclrgs! 'gs gkhjg%gs ch chspocls, ch `ohrrhs pgtrljgbhs, ch

rh`ljvhrsoljhs, tgbgcrgj su `lj`ohj`og!

Bg `rosos `ljtojug uj prl`hsl ch `ljtrgrrh$lbu`oj quh gukhjtg bg hnlbgtrg chb sb$hsh quohj puhcg

bg `legrcg `lbh`to$g pgrg phbhgr plr uj kujcl rgco`gbkhjth ltrl. &lcgs bgs `rosos sl`ogbhs slj

lplrtujocgchs pgrg `gkeogr bg aostlrog. Hj hstg quh jls ag tl`gcl, bgs `bgshs plpubgrhs $gj g sgbor

ks chshstru`turgcgs chrrltgcgs ch bl quh hjtrgrlj) phrchrj bg egtgbbg soj jo soquohrg agehrphbhgcl. ohigs pgbgergs `lkl l`upg`oj ch fero`gs, gutlnhstoj, jg`oljgbo!g`oljhs slj fsobhs

bojnJsto`ls pgrg ujls `lbh`to$ls sojco`gbhs quh `lkl hj hb `aosth sbl pochj g sus sh'lrhs quhcgrsh

`lkl hstj .

>h pgrh`h plr hbbl hstg chrrltg lerhrg g hsls hphrokhjtls ch 1jchfhjsoj /prhjcocg hj quh bls

gjokgbhs ch hphrokhjtg`oj slkhtocls g `gstonls hj ujg pos`ojg sh chigj klror `ugjcl gj tohjhj

hjhrngs leihto$gs pgrg phbhgr. Hb clblr `lbh`to$l bg gjsohcgc prlcu ocg plr hb rohsnl ch

jhlplerh!g hst `lkl bgs kgbgs sgbsgs soj bongr plr jojnujg lrngjo!g`oj quh bh c% flrkg sgbocgs

`lbh`to$gs .

(h `ljtojugr bg thjchj`og g`tugb bgs `gpgs plpubgrhs sgbcrj sueihto$g leihto$gkhjth kskgbtrh`ags ch bl quh hjtrgrlj g ko iuo`ol sh g`hjtugrj thjchj`ogs rhg``oljgrogs quh cof`obkhjth

okgnojgkls chspbg!gjcl bg rgeog `ljtrg bls hkonrgjths jl `ljtrg bls plchrlsls. (h `ugbquohr

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

9/12

flrkg bg aostlrog jl hst juj`g hs`rotg chb tlcl `lkl hs`roeo *rh`at hj su okprhs`ojcoebh ;cg g

bg cogb%`to`g# bls chrrltgcls ch al slj bls $hj`hclrhs chb kg'gjg. hrl pgrg hbbl, quo!s phrchr bg

hsphrgj!g ch euhjg $ocg hj hb khr`gcl l hj bls eohjhstgrhs ch bg pso`lblno!g`oj hs uj pgsl

okprhs`ojcoebh pgrg sgbor ch hsg ojchfhjsoj ch`ocorsh g phbhgr `lj bgs fuhr!gs quh gj quhcgj

Wu puhch (g`hr uj pso`blnl, uj psoquogtrg gjth bg chshsphrg oj ch hstgs phrsljgs

trg$gigclrgs! /h`orbhs quh (gngj bg rhvlbu`oj!uhch trgtgr ch hj`ugcrgr hsh sufrokohjtl sueihto$l hj bl okphrsljgb, okpocohjcl hb prl`hsl ch

ojco$ocug`oj l ch `ubpgeobo!g`oj quh g'gch koshrog pso`lbno`g g bg h`ljko`l-sl`ogb. >gehr quh

hb pgrl tl`g `lkl bg blthrg gb rh$%s# trgjquobo!g g quo%j eus`g `gusgs rhkhcols pso`lbno`ls ch

su kgb$o$or hj su eolnrgfg prhnujtjclsh qu% ao`h kgb. &rgtgr ch `rhgr $j`ubls jl prlfhsoljgbhs

hjtrh pgrgcls, hjtrh phrsljgs `lj sufrokohjtls htoquhtgcls ch chprhso$l-gjsolsls cgr flrkgs ch

ojthrprhtgr bg gjnustog-chprhsoj hj uj kgr`l `lbh`to$l quh eusquh gnrupgr shuclhjfhrkls hj rhchs

ch gpll `ljsukl pgrgbhbl puhchj shr sunhrocgs chsch bgs `ljsubtgs .

Bls fujcgclrhs ch /b`labo`ls /jjokls phrsostohrlj hj ehehr kohjtrgs oegj ch pso`blnl hj

psoquogtrg plr tlcl hb kujcl. (higrlj ch ehehr `rhgrlj bg rhc ch gutlgucg ks plthjth chb

pbgjhtg, `ugjcl tlkgrlj `lj`ohj`og quh hj bg gucg kutug sh plcgj `rhgr bgs rhchs t%`jo`gs quhh$otgj ehehr. >ohkprh kh ag pgrh`ocl uj hihkpbl g shnuor .

Hb kl$okohjtl fhkojostg tohjh hphrohj`ogs sokobgrhs) bgs ch *lstlj blnrgrlj rhgprlpogrsh ch ujls

`uhrpls kutobgcls plr bg nojh`lblng. &hjhr $gblr pgrg phjsgr g`tugr chsch bg hphrohj`og

g`ukubgcg puhch blnrgrsh chsch g `ljfhsoj ch okplthj`og prlfhsoljgb ch bls pso blnls l

psoquogtrgs so tu$ohshj aljrgch! pgrg gutlh$gbugr rhgbkhjth su prg`to`g rhgb tgj pl`l hfo`g! hj

gbo$ogr hb clblr sueihto$l

=sthc (g gforkgcl quh 6$gil rtubls pso`lthrgputo`ls, chthrkojgcls gpgrgtls $url`r)to`ls

`ljstotuyhj cosplsotovls ch prlcu``oj ch ochjtocgchs chstojgcls g ojcovocugbo%gr hb

sufrokohjtl prlcu`ocl plr bg `rosos y hvotgjcl gs `ugbquohr hstrgthnog `lbh`tovg>. Hs ujg

hstrgthnog `ljs`ohjth hj su lpojoj! Hs ujg su$lrcojg`oj g bls ojthrhshs chb `gpotgb!

?jl ch bls rgsnls `hjtrgbhs chb juh$l hsprotu chb `gpotgboskl hs quh jl jh`hsotg `lj`ohj`og l

ochlblng clkojgjth pgrg okpljhr su co`tgcl) `lj quh sh `ljsukg sh slkhtgj bgs plebg`oljhs gb

r%nokhj ch jh`hsocgchs quh bg prlpgngjcg `rhgL / bls nrgjchs kljlplbols jl bh okplrtg hb

phjsgkohjtl ch bg nhjth .

Hj hsh shjtocl bg pso`lblno!g`oj jl hs ujg pr`to`g `ljs`ohjth chb `gpotgboskl plrquh jl bg

jh`hsotg. >okpbhkhjth `lj quh hb puhebl sh hj`ohrrh hj su `gsg, su pgrhig lb$och bls $ohigs

ochjtocgchs egsgcgs hj nrupls jgturgbhs, bg $o`tlrog ch sgj khr`gcl hst gshnurgcg. >o jl ag uj5lsltrls chsch hb quh $o$or hb l su`hso$l hs hb jo`l pujtl chsch hb quh sh rhfbholjg hb

`gpotgboskl puhch chigr fbltgr g hsls ojco$oculs quh hs`ligj `ugbquohr ochlblng quh jl rh`rhh

hsls $j`ubls. rh`osgkhjth hb gjto`bhro`gboskl ch bls plstklchrjls gtufg g hsh chshl ch boquocgr

oj`busl bg ochlblng `lkujotgrog quh hj tohkpls bhs sor$o quh hj bl quh tohjh ch 5lsltrls

1chjtotgrol bhs rhsubtg ujg pgrgcio`g rhsosthj`og g phsgr ch bl gjto`ugcl ch sus prlthstgs.

]uo!s gb Hstgcl g bls plbto`ls s bhs ojthrhsg gpgrhjtgr ujg hfo`g`og ch bg quh `grh`hj pgrg ojfbuor

hj bg $ocg rhgb ch bgs phrsljgs h ochlbongr ujg shnurocgc sl`ogb frhjth g bls g!grhs h`ljko`ls

supljng uj kh`gjoskl ch h$otgr hb chsojthr%s ch bg plebg`oj slerh bl plbto`l. /forkgr quh gb

khjls hb hstgcl puhch cgr hs`uhbg `hjtrls ch sgbuc chsch bg o!quohrcg puhchs shr uj kh`gjoskl

ch fochbo!gr ujgs kgsgs g `lj$hj`ocgs ch bg ojgjocgc chb hstgcl pgrg ojfbuor hj hb pgrl l bg $ocgrhgb.

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

10/12

Pgbuc y khjtgb y rhbg`oljhs ch prlcu``oj `gpotgbostgs, slj trkojls quh phrkothj

`lj`obog`oj hj su lpojoj! Hb `gpotgboskl, plr hb `ljtrgrol, hs hjhkonl ch bg sgbuc khjtgb ch

bgs phrsljgs!

Bls hfh`tls pgtlbno`ls chb `gpotgboskl slerh bg sgbuc khjtgb jl jg`hj ch ujg $lbujtgc kgbonjg quh

ag`g nrotgr g bg *ruig /$hrg o$g hb 0gb. o$g hb @gpotgbW# sojl ch quh hj su jh`hsocgc ch

kubtopbo`gr sus ngjgj`ogs $hjcohjcl juh$gs khr`gj`gs prh`osg `rhgr jh`hsocgchs `ljtojugs hj bgsphrsljgs plr hbbl sh trgjsflrkg hj uj sosthkg quh jh`hsotg prlcu`or ochjtocgchs egsgcgs hj ujg

hsph`oh ch nbltljhrg `ljsukostg quh jl sh sgtosfg`h juj`g. @ujtl hs egstgjthK sh rhspljch chsch

hb khr`gcl `lj uj 5uj`g quh nhjhrg gjsohcgc `ljtojug hj bgs phrsljgs. Bg slerohcgc bg

`ljfonurg`oj ch ujls nustls ujgs sgtosfg``oljhs gb kgrnhj ch bgs shucljh`hsocgchs `rhgcgs

chsch bg ochlblng `gpotgbostg slj hb prokhr pgsl pgrg gcquoror ujg cof`ob sgbuc khjtgb sohkprh

`hr`gcgs plrquh gbnj fhto`ah lfrh`ocl plr bg puebo`ocgc -tgb $ogih, tgb `l`ah, tgb `gsg- g`ohrth g

hjbg!gr `lj gbnujg phr$hrsoj prlpog jls agng $hjchr bg $ocg pgrg `gkeogrbg plr cojhrl pgrg

`lkprgr hsls prlcu`tls cltgcls chb hj`gjtl kno`l ch bg khr`gj`g quh gcquohrh bl ojthrolro!gcl

`lkl chshl. Hb suihtl tgb `lkl bl `ljl`hkls hs tgj $lrg! tgj kgbcltgcl ch 6oeros ch fgbtg ch

frhjl g sus gjsogs, quh prh`osg uj sosthkg ku rg`oljgb pgrg `ljthjhrsh .

o$or slerols shr uj pl`l kliongtls kh pgrh`h uj `ljshil pruchjth hj hstls tohkpls ch

halrtg`oj g boehrgr hb chshl l gtrh$hrsh g tlcl `lkl sonjl ch sgbuc khjtgb. Chprokorsh frhjth g bg

chsuebokg`olj rhprhso$g ch bg quh jls agebgeg 0gr`ush `lkl `grg`thrsto`g chb plst`gpotgboskl hs

ujg rhfbhoj jh`hsgrog g phsgr ch quh suhjh g phjsgkohjtl rhg``oljgrol

;gk$oj usthc (g gforkgcl quh bls hstucols ch hpochkolblng psoquo)tro`g sh*gbgj g quh bg

`lj`ohj`og ch `bgsh, hb `gpotgb sl`ogb, hs uj rhkhcol 6quh gthkphrg bg vubjhrg$obocgc y

gukhjtg bg rhsosthj`og frhjth g bg chprhsoj plr hstrs bg$lrgb>. 9lr qu! +kl g`t&g

plsotovgkhjth 6hb nrgcl ch rh`oprl`ocgc y `ljfogj%g hj bgs rhbg`oljhs flrkgbhs h ojflrkgbhs

hjtrh phrsljgs, quh fg`obotg bg g``oj `lbh`tovg hj $&squhcg ch $hjhfo`ol kutul>! Uh`lrcg$g

usthc quh uj okph`g$bh hstucol fojbgjcs sl$rh 7:.555 trg$gigclrhs klstr hsh `gpotgb sl`ogb

`lkl khilr prhhcotlr ch rohsnlh onjlrg g $h`hs quh bls hstucols ch Hbtlj 0gl quh cohrlj `lehrturg g bg ochlblng tgblrostg quh

boquoc bg `ubturg ch `bgsh hj bgs nrgjchs ojcustrogs gkhro`gjgs hs hb hstucol ch uj pso`lgjgbostg quh

rh`lj$ohrth `ugbquohr quhig `ljtrg hb `gpgtg! l hb pgtrj hj prlh``oljhs ch ujg kgbg okgnhj

fgkobogr. >us bgrngs hjtrh$ostgs g bgs lerhrgs ch :hjhrgb Hbh`tro` tohjh uj flrkgtl pso`lcojko`l

cljch gforkg quh trgs hb lcol ch `bgsh sh trgsbu`h bls fgjtgskgs hcpo`ls ch lcol gb pgcrh. Hs ch`or,

hb kgbhstgr hj bg fero`g shrg uj rhj`lr $hrtocl hj bg fero`g phrl `ljstruocl hj bl fgkobogr.

@lj$hrtor g `gcg nhrhjth hj uj pso`blnl fuh bg rh`htg quh tgjtl %otl col g bg prlcu`to$ocgc

tgblrostg) trgs `gcg chkgnlnl ag uj jhurto`l# fuh bg frkubg quh phrkoto hb trgtgkohjtlojco$ocugbo!gcl chb kgbhstgr lerhrl htoquhtgcl ch rhshjtokohjtl.

Bls pso`blnls ch hkprhsg eus`gj plr hbbl ochjtofo`gr g hsls suihtls ojgcgptgcls pgrg chsg`to$gr

`ugbquohr `lbh`to$o!g`oj l prlthstg quh sukh kgbhstgrhs, pgrg trgtgr ojco$ocul g ojco$ocul hsg

prlh``oj# chb sufrokohjtl ojtokl quh sh $ohrth hj bg fero`g

?jls pl`ls hstucols gjgbo!gj bls `lbh`to$ls g`to$gjcl su khklrog `lbh`to$g, gjgbo!gjcl bl quh ag

ch `lkj hj bgs aukobbg`oljhs ch bg `gchjg `ugjcl ag quh phcor phrkosl pgrg or g khgr l

`gkeogrsh hb tkpg `lj ojchphjchj`og ch bg phrsljgbocgc l bg aostlrog ojco$ocugb. Hj hsg khklrog

nrupgb sh chs`uerh bl pl`l ojco$ocugbo!gcg quh hs bg jhurlsos chb trgegigclr quh $o$h `lkl fgtong

cg'l fso`l-psquo`l bg rhcu``oj ch su $ocg g tohkpl ch trgegil. >h puhch oj`busl khcor `lklgukhjtgj bls `ljsukls ch gb`lalb l bgs rupturgs ch pgrhig hj rhbg`oj g `rosos bgelrgbhs .

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

11/12

Bg koshrog ch bgs lrngjo!g`oljhs sojco`gbhs sh puhch $osugbo!gr hj su oj`gpg`ocgc pgrg grto`ubgr hsls

hstucols quh plsoeobotgrgj uj rhbgtl `lbh`to$l chb cg'l bgelrgb soj rhcu`orbl gb hsquhkg ch hstr%s

bgelrgb prlcu`tls ch chprhsoj- gjsohcgc hj fuj`oj ch bg $ubjhrgeobocgc phrsljgb.

Bg `ubturg pso`lbno`g chb jlrth ch Hurlpg `ljshr$g rhstls chb gjtonul pg`tl sl`ogb quh phrkotg

sustotuor bg `lnhstoj plr khcocgs sojco`gbhs ku bongcgs g bg egsh quh chigrlj ujg kgnrg `lsh`ag

ch hstucols slerh hb pgphb prlth`tlr ch bg gsgkebhg hj bg aonohjh khjtgb ch bls trgegigclrhs frhjth gbls `lkot%s ch shnurocgc hj hb trgegil. Hj hsh shjtocl bls hquo$gbhjths hkpro`ls ch bg `lj`ohj`og ch

`bgsh -gsosthj`og g gsgkebhgs, pgrto`opg`oj hj `lkot%s ch sgbuc bgelrgb, `ljstru``oj ch rhchs

gkostlsgs chsch bg fgero`g- sukojostrgj prlth``oj hfo`g! frhjth g egigs bgelrgbhs plr chprhsoj-

gjsohcgc

Mpujtg$g tgk$oj usthc hj ujg `grtg gb `lbh`tovl ch Hspgo 3gr# quh `ugjcl gbnuohj sh sohjth

g`lsgcl hj ujg hkprhsg su &jo`g chfhjsg rhgb slj bgs rhbg oljhs (lro%ljtgbhs `lj sus

`lkpg*hrls, `lj hsgs rhbg`oljhs bgs quh bh puhchj phrkotor gjgbo%gr su sufrokohjtl hj

trkojls `lbh`tovls y hj`ljtrgr gplyls rhgbhs hj hsh `lbh`tovl. Wu topl ch gplyl puhch

hj`ljtrgr uj trg$gigclr chshsphrgcl hjtrh `lkpg*hrls jl khjls chshsphrgcls hj l`gsoljhs!

Bg hs`u`ag ch gbnuohj quh $o$h bgs prlpogs `ljco`oljhs bgelrgbhs g hs thrgp%uto`g plrquh g

cofhrhj`og ch bg hs`u`ag pso`lbno`g hs ujg hs`u`ag hjkgr`gcg jl chs`ljthtugbo!gcg hj bg quh sh

`lkpgrthj $gblrhs sh puhch g`tugr slerh bg sotug`oj rhgb quh nhjhrg hb kgbhstgr. (h hsg hs`u`ag

sohkprh jg`hj flrkgs ch ko`rl slbocgrocgchs quh sh trgcu`hj hj phquh'ls g`tls ch rhsosthj`og

sgeltgih g bls rotkls bgelrgbhs l g bls geusls ch bls ch grroeg. Hj uj tgbbhr ch `gbchrhrg `ugjcl

hjtrgeg hb ojnhjohrl `lkhj!grlj g `ghr ahrrgkohjtgs chsch bls gjcgkols g su pgsl `lj bl quh bgs

$osotgs s h ao`ohrlj ojfrh`uhjths. &rgs gbnujgs `hjgs jg$och'gs hj ujls gstobbhrls noiljhshs bls

`l`ahs ch bls hj`grngcls gpgrh`ohrlj pojtgrrgihgcls. &rgs bgs fohstgs ch `lkgcrhs hj :oij bgs

lerhrgs chb thtob sh rhgforkgrlj hj jl gegjcljgr uj hj`ohrrl quh cur g'ls. (h hsls `ljtg`tls

hsplrco`ls egsgcls hj hs`u`ags kutugs, g sgbor chb trgegil `lkpgrtor `ltocogjocgc `rhgjcl hsgs

rhchs hsls $j`ubls quh phrkothj `ljstruor uj 5lsltrls ujgs rutojgs `lkujhs jl ag ku`ag

costgj`og kh pgrh`h hb jo`l kgjugb ch suphr$o$hj`og quh `ljl!`l frhjth gb ojco$ocugboskl quh

thrkojg hj ujg hsph`oh ch jgr`ososkl hnltostg hj bg quh `ugbquohr phrcocg gfh`to$g bbh$g g bg

chprhsoj.

2g`h kuy pl`l (g fgbbh`ocl +grbls +gstobbg chb 9ojl. Wu (g sonjofo`gcl +gstobbg chb 9ojl hj

bg (ostlrog rh`ohjth ch bg psoquogtrg hspg*lbg!

hrcj plr `otgrkh phrl ah hs`rotl uj bgrnl grto`ubl slerh @gstobbg chb quh fuo euhj gkonl quh

plc%os rhprlcu`or hj $uhstrl plrtgb. Hj %b plr ch`orbl ch flrkg sojt%to`g gforkl quh kohjtrgs su

fonurg hrg g`bgkgcg plr bg psoquogtrg ch o!quohrcg curgjth sus rhujoljhs, bg pr`to`g rhgb ch hslspsoquogtrgs prlnrhsostgs sh `lrrhspljcg khilr `lj bg chb nrgj psoquogtrg chb frgjquoskl Bph!

1elr . Hsth gfork `lkl thsos `hjtrgb quh bgs jhurlsos hrgj hjfhrkhcgchs chb jokl quh jl

prh`osgegj pso`lthrgpog sojl gjtochprhso$ls#. 5l ag gphjgs jojnj jhurto`l al hj Hspg'g quh

jl rh`oeg clsos khcol gbtgs ch gjtochprhso$ls ch g`uhrcl `lj hsgs thsos. @lkl hj tgjtgs `lsgs hb

torgjl chil bgs `lsgs gtgcgs eohj gtgcgs kohjtrgs hj bl ochlbno`l sh gbgeg g @gstobbg hj bg

prg`to`g sh g`tg `lj bgs ochgs bg bno`g chb frgjquoskl

Gojgbkhjth, (g$bgjcl ujg vh% k)s ch khklrog (ostro`g, uj psoquogtrg kobotgr, hb sh*lr

Egbbhil @)ihrg, `gbofo` g bls rlils hspg*lbhs ch hjfhrkls khjtgbhs. 9rlpusl trgtgrbhs `lkl

tgbhs y `rhl quh bl `ljsonuo. Hrg hsl sg$hr `ohjtfo l, ochlblng psoquo)tro g, fgjgtoskl

hjvuhbtl hj trkojls pshucl`ohjtfo`ls!

gbbhil 5ihrg fuh ujg fohb hprhsoj ch bgs `ljtrgco``oljhs chb frgjquoskl. Hs`roeo thtls slerh bg

8/2/2019 La psiquiatra actua lDSM III Guillermo Rendueles

12/12

sokubg`oj psoquotro`g quh bbh$grlj gb pgrhcj g egstgjths rlils quh trgtgegj ch ag`hrsh pgsgr plr

bl`ls, hs`upo slerh bls ojthrjg`oljgbostgs `lj ujls hstucols hpochkolbno`ls rhpunjgjths, klrgbo!

g kuihrhs jo'ls `rhgjcl hj bls g'ls `ugrhjtg ujgs ojstotu`oljhs ch rhprhsoj bbgkgcgs gtrljgtls

ch rlth``oj g bg 0uihr quh $onobgegj `gstongegj bgs fgbtgs gb gklrgb kljiob quh hb co`tgclr

okpusl. grg `lbkl hs`roeo uj trgtgcl ch psoquogtrg egsgcl hj bg pso`lblng ch >gjtl &lkgs ch

/quojl `lj gpgrtgcls slerh bg pgtlblng ch bg $lbujtgc ltrls cospgrgths sokobgrhs quh fuh lebongcl

kgjugb hj bgs fg`ubtgchs ch khco`ojg frgjquostgs.

hrl frhjth g bg kglrg ch bg psoquogtrg rhpuebo`gjg jl sh gpujt plr klto$ls rhbonolsls g gplgr

bg hunhjhsog ch bls pg`ohjths khjtgbhs quh fuh hb `rokhj `gpotgb ch bg psoquogtrg chb sonbl quh

hjtlj`hs sh ojo`ogeg quh ku`als ch bls `ohjtfo`ls ch o!quohrcg `lj egsh hj hb cgrMojoskl

gplgrlj. Bgflrg, hb nrgj psoquogtrg ch bg Chpebo`g, eohj hjtrgcls bls g'ls `ugrhjtg, gj chfhjcg

bg hsthrobo!g`oj ch bls pg`ohjths khjtgbhs nrg$hs. grols `ohjtfo`ls h ojthbh`tugbhs ch bg Bong pgrg bg

Chflrkg >hugb hj`geh!gcg plr /urlrg Clcrnuh! gprlegegj hb usl chb ngs `o`bj pgrg hbokojgr

bgs $ocgs soj $gblr# .

Hj hsh shjtocl l ah kgjthjocl hj gbnujls thtl `lkl ag ku pl`l quh lpljhr g bg psoquogtrg

fgs`ostg rhprhshjtgcg plr gbbhil plrquh hjfrhjth jl ag jojnj psoquogtrg gb shr$o`ol ch bg rg!jboehrgclrg. 6geg ujg pr`to`g psoquotro`g rhpuebo`gjg chfhjslrg chb kgjo`lkol prl$oj`ogb, ujg

aonohjh khjtgb egsgcg hj bg hunhjhsog thrrlrfo`g, hb trgtgkohjtl chb pjo`l chb slbcgcl `hr`gjl gb

frhjth pgrg rhojthnrgrbls gb kgtgchrl uj bgrnl alrrlr quh ag`h cof obkhjth chfhjcoebh bg

`ljtrgco``oj hjtrh ujg psoquogtrg fgs`ostg frhjth g ltrg ch o!quohrcg. /kegs flrkgegj uj tltuk

rh$lbutuk hj quh ageg ku pl`l ch euhjl.

Nrg`ogs, nrg`ogs plr su tohkpl y plr sus nhjhrlsgs y slbocgrogs rhspuhstgs.

(ttp844khngfljlhjtrhvostgs.$blnsplt.`lk.hs4C5544hjtrhvostg