Concerns Over Divergent Approaches in the Diagnostics of Posttraumatic Stress Disorder

Abstract

Since the inception of posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), there has been an ongoing polemic debate about the veracity, assessment, neurobiology, and longitudinal course of the disorder. As a consequence, its clinical utility has been the subject of a significant amount of conflicting opinion due to the competing interests involving clinicians, insurance companies, victim's groups, and governments. This article reviews some of the current divergent approaches in the diagnosis of PTSD, including the debate on the condition itself, claims that it is overdiagnosed, the usefulness of the "A" criterion, equivalence of cluster criteria, the role of combat and civilian PTSD, the role of biomarkers, incongruences in diagnostic practice, and the need for a consistent approach that ensures diagnostic congruence. Critical drivers of divergent diagnostic systems are that they should not produce significantly different rates or produce high levels of discordance. However, one of the concerns is that the anticipated International Statistical Classification of Diseases and Related Health Problems, eleventh edition (ICD-11) has moved away from this primary aim and taken a markedly divergent approach that is incompatible with the advancement of consensus within this critical field. This article explores some of the primary arguments and evidence cited for this approach in ICD-11 and recent changes in

A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD

“…It has also been argued (Vermetten, Baker, Jetly, & McFarlane, 2016) that divergent diagnostic systems should not produce significantly different prevalence rates or high levels of discordance. The authors suggest that the ICD-11 proposals are incompatible with the advancement of consensus within the field.…”

A new perspective on PTSD symptoms after traumatic vs stressful life events and the role of gender

“…Anders, Frazier, & Frankfurt, 2011; Cameron, Palm, & Follette, 2010; Gold, Marx, Soler-Baillo, & Sloan, 2005; Long et al, 2008; Mol et al, 2005; Roberts et al, 2012; Robinson & Larson, 2010), questioning the constricted definition of traumatic A1 events. In this regard, in contrast to the DSM-5, the ICD-11 will differentiate less between effects of formal DSM traumatic (A1) events and other (non-A1) stressful life events (World Health Organization), and diagnosis of PTSD will mainly be based on PTSD symptom presentation (Maercker et al, 2013; World Health Organization; Vermetten, Baker, Jetly, & McFarlane, 2016). Hence, this calls for a renewed discussion on the role of stressful life events in the development of PTSD.…”

Trauma and Public Mental Health: A Focused Review

“…This is a major concern for the field of traumatic stress studies. It is a challenge for future research to unravel the differences and to create order (6), as most research is conducted with the DSM definition while most countries in the world use instead ICD.…”

“…Despite the increased knowledge about PTSD and despite the positive results of therapeutic treatments for PTSD, there are various dilemmas and challenges. First, there is a large comorbidity, as most patients also suffer from depression, substance abuse, or other disorders (6). Furthermore, defining the borderline between normal and abnormal behavior after trauma is difficult.…”