DSM-5 and Icd-11 Definitions of Posttraumatic Stress Disorder: Investigating “Narrow” and “Broad” Approaches

Abstract

Background The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. Methods WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSMIV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. Results A total of 5.6% of respondents met criteria for “broadly defined” PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. Conclusions These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies.

Comparison of DSM-5 and proposed ICD-11 criteria for PTSD with DSM-IV and ICD-10: changes in PTSD prevalence in military personnel

“…In line with our hypothesis and consistent with previous findings (Carmassi et al, 2013; Elhai et al, 2009, 2012; Gentes et al, 2014; Kilpatrick et al, 2013; Miller et al, 2013; O’Donnell et al, 2014; Stein et al, 2014), no change in provisional PTSD prevalence was identified when the criteria shifted from DSM-IV to DSM-5. Although, DSM-IV and DSM-5 include a different number of qualifying symptoms, group these symptoms into specific clusters, and thus implicitly demand specific symptom characteristics to be present in a minimum number and specific combination, possibly leading to the identification of somewhat different patient populations in the present study, the agreement between both systems was satisfactory.…”

“…To our knowledge, only two studies to date have systematically compared all four diagnostic systems, again yielding inconsistent results. Whereas Stein et al (2014) found no differences in PTSD prevalence at all, O’Donnell et al (2014) reported no differences between DSM-5 and DSM-IV, but lower PTSD prevalence under the proposed ICD-11 compared to DSM-IV, DSM-5, and ICD-10. Notably, although interpretation of prevalence differences between different diagnostic systems is limited when no consistency is reported, analyses of agreement between the diagnostic systems are provided only by some authors (Carmassi et al, 2013; Elhai et al, 2009; Gentes et al, 2014; Kilpatrick et al, 2013; Morina et al, 2014; Stammel et al, 2015).…”

“…Of special concern for this study was the concordance when self-rated questionnaires were scored following the diagnostic rules of DSM-IV, DSM-5, ICD-10, and proposed ICD-11 criteria for PTSD. It is of note that most earlier studies in this area used clinician-administered interviews to check for a positive diagnosis of PTSD (Elhai et al, 2009; Forbes et al, 2011; Gentes et al, 2014; Morina et al, 2014; O’Donnell et al, 2014; Stein et al, 2014; van Emmerik & Kamphuis, 2011; Wisco et al, 2016). While this is without doubt the gold standard for clinical research, clinical practice often heavily relies on self-administered instruments, underlining the importance of investigating the consistency when self-rating instruments for PTSD are provided.…”

“…While this is without doubt the gold standard for clinical research, clinical practice often heavily relies on self-administered instruments, underlining the importance of investigating the consistency when self-rating instruments for PTSD are provided. Based on research findings, we expected that the PTSD prevalence would be the same using DSM-IV versus DSM-5 criteria (Carmassi et al, 2013; Elhai et al, 2012; Gentes et al, 2014; Kilpatrick et al, 2013; Miller et al, 2013; O’Donnell et al, 2014; Stein et al, 2014), but would be reduced under the ICD-11 proposal as compared to ICD-10 and DSM-5 (O’Donnell et al, 2014; Wisco et al, 2016). …”

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

“…Epidemiological studies indicate that the age-standardized point prevalence of PTSD and major depression in conflict-affected populations is estimated to be 12.9% and 7.6%, respectively (Charlson et al, 2016). As a comparison, it has been estimated that approximately 4.4% of the world population suffers from major depression (WHO, 2017) and 3.3% from PTSD (Stein et al, 2014). Although good epidemiological data on psychosis is lacking, it is also likely that psychotic symptoms in Syrians have increased (Hassan et al, 2016; Hijazi & Weissbecker, 2015).…”