Comparing the dimensional structure and diagnostic algorithms between DSM-5 and ICD-11 PTSD in children and adolescents

Abstract

In contrast to the DSM-5, which expanded the posttraumatic stress disorder (PTSD) symptom profile to 20 symptoms, a workgroup of the upcoming ICD-11 suggested a reduced symptom profile with six symptoms for PTSD. Therefore, the objective of the study was to investigate the dimensional structure of DSM-5 and ICD-11 PTSD in a clinical sample of trauma-exposed children and adolescents and to compare the diagnostic rates of PTSD between diagnostic systems. The study sample consisted of 475 self-reports and 424 caregiver-reports on the child and adolescent trauma screen (CATS), which were collected at pediatric mental health clinics in the US, Norway and Germany. The factor structure of the PTSD construct as defined in the DSM-5 and in alternative models of both DSM-5 and ICD-11 was investigated using confirmatory factor analyses (CFA). To evaluate differences in PTSD prevalence, McNemar's tests for correlated proportions were used. CFA results demonstrated excellent model fit for the proposed ICD-11 model of PTSD. For the DSM-5 models we found the best fit for the hybrid model. Diagnostic rates were significantly lower according to ICD-11 (self-report: 23.4%; caregiver-report: 16.5%) compared with the DSM-5 (self-report: 37.8%; caregiver-report: 31.8%). Agreement was low between diagnostic systems. Study findings provide support for an alternative latent dimensionality of DSM-5 PTSD in children and adolescents. The conceptualization of ICD-11 PTSD shows an excellent fit. Inconsistent PTSD constructs and significantly diverging diagnostic rates between DSM-5 and the ICD-11 will result in major challenges for researchers and clinicians in the field of psychotraumatology.

The importance of theDSM‐5posttraumatic stress disorder symptoms of cognitions and mood in traumatized children and adolescents: two network approaches

“…() found that becoming physiologically reactive and upset in response to reminders of the trauma may represent key drivers in the symptom network. These divergent results may be partially explained by differing adult symptomatology, where reexperiencing symptoms may play a more central role (Sachser et al., ), and by the use of the DSM‐IV conceptualization of PTSD, which lacks our most central symptoms in the regularized partial correlation networks and the driving forces in the DAGs: negative trauma‐related cognitions and persistent negative emotional state .…”

“…The mean total symptom score for the self‐report sample (CATS M US = 25.98 , CATS M Germany = 22.98, CATS M Norway = 20.68) and the caregiver‐report sample (CATS M US = 24.88 , CATS M Germany = 20.76, CATS M Norway = 15.84) reflects that traumatized children and adolescents in this study had a high mean severity of PTSS. Applying the DSM‐5 algorithm (itemscore ≥ 2) about 38% of children and adolescents could have been diagnosed with possible PTSD (Sachser et al., ).…”

“…With regard to children and adolescents, one study found similar rates for DSM‐5 and ICD‐11 PTSD in traumatized children and adolescents (Danzi & La Greca, ). In contrast, two other recent studies have found that the restricted ICD‐11 PTSD criteria resulted in lower prevalence rates compared with DSM‐5 or DSM‐IV in clinical samples of children and adolescents (Sachser & Goldbeck, ; Sachser et al., ) and it has been recognized that children and adolescents express disorders in different ways (House, ). Regarding PTSD, children and adolescents appear to demonstrate different symptoms and a wider range of associated symptoms compared to adults after being exposed to traumatic events (Scheeringa, Zeanah, Drell, & Larrieu, ).…”

Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis

“…In support of the ICD‐11 approach, Sachser et al. () found a PTSD diagnosis reduced to its core symptoms to be appropriate for children and adolescents. Furthermore, studies that investigated the PTSD factor structure in children and adolescents showed that treating the core PTSD symptoms as a specific entity distinct from depression and generic emotional distress provided the best model fit (Kassam‐Adams, Marsac, & Cirilli, ) and reduced PTSD‐depression comorbidity (Ford, Elhai, Ruggiero, & Frueh, ).…”

“…However, Sachser et al. () argue that including intrusive memories might be important to account for developmentally different presentations of re‐experiencing symptoms in children and adolescents.…”