Les critères d’identification de la schizophrénie ont connu une évolution entre le DSM-IV-TR et le DSM-5. Dans cette recherche préliminaire, nous illustrons ce basculement avec l’étude de deux femmes issues de la population non clinique qui affirment entendre des voix depuis plusieurs années et qui en font même une ressource pour leurs activités de médium. Dans une approche de recherche clinique cherchant à réduire la stigmatisation de « l’entente de voix » et à mieux saisir sa phénoménologie en contexte, nous avons utilisé l’entretien semi-structuré de Maastricht développé par Romme et Escher. Les données collectées au cours d’une série d’entretiens ont également permis de compléter l’échelle d’évaluation dimensionnelle de la sévérité des symptômes psychotiques du DSM-5. Pour les deux sujets, les données indiquent un diagnostic de schizophrénie paranoïde selon les critères A du DSM-IV-TR, alors qu’aucun diagnostic n’a pu être identifié selon les critères du DSM-5. Ces éléments semblent indiquer une réelle évolution pour le diagnostic de la schizophrénie en fonction de la nosographie utilisée et laissent présager une évolution de la perception de cette pathologie par les cliniciens et les usagers.

Schizophrenia criteria have evolved between DSM-IV-TR and DSM-5, in particular with the removal of the different subtypes of the pathology and the instruction “Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other”. These changes could have a specific impact for the diagnosis of people reporting acoustico-verbal hallucinations.

In this preliminary research, we illustrate this shift with the study of two women from the non-clinical population who claim to hear voices since several years and who even make it a resource for their mediumship activities.

In a clinical research approach seeking to reduce the stigmatization of “voice hearing” and to better understand its phenomenology in context, we used Maastricht semi-structured interview developed by Romme and Escher. The data collected during a series of interviews also allow to complete the DSM-5's dimensional assessment of the severity of psychotic symptoms.

For both subjects, the data indicate a diagnosis of paranoid schizophrenia according to DSM-IV-TR criteria A, whereas no diagnosis could be identified according to DSM-5 criteria. The difference in diagnosis between the last two versions of the DSM focuses on criterion A relating to hallucinations, and in particular acoustico-verbal hallucinations, which have long been considered as almost pathognomonic symptoms of schizophrenia. In the new nosography, the presence of another criterion A is required in order to make the same observation. The integration of these acoustic-verbal hallucinations into finer differential clinical practice could be the common result of a pressure of new mentalities on a classification particularly permeable to this type of influence, and of recent research in favour of a fully dimensional approach to psychotic experiences. These diagnosis hesitations are also discussed with reference to the French Classification of Mental Disorders R-2015, which points to the possibility of an organic disorder in front of the same clinical elements while giving less importance to positive symptoms.

These elements seem to indicate a real evolution in the diagnosis of schizophrenia according to the nosography used and suggest a change in the perception of this pathology by clinicians and users.