DSM‐5 and ICD‐11 definitions of posttraumatic stress disorder: Investigating “narrow” and “broad” approaches

Authors

Dan J. Stein, University of Cape Town
Katie A. McLaughlin, University of Washington
Karestan C. Koenen, Columbia University
Lukoye Atwoli, Aga Khan UniversityFollow
Matthew J. Friedman, National Center for PTSD, US Department of Veteran Affairs, VA Medical Center
Eric D. Hill, Harvard University
Andreas Maercker, University of Zurich
Maria Petukhova, Harvard University
Victoria Shahly, University of Zurich
Mark van Ommeren, World Health Organization, Geneva, Switzerland

Document Type

Article

Department

Internal Medicine (East Africa)

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. DSM-IV 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.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Depress & Anxiety

Recommended Citation

Stein, D. J., McLaughlin, K. A., Koenen, K. C., Atwoli, L., Friedman, M. J., Hill, E. D., Maercker, A., Petukhova, M., Shahly, V., Ommeren, M. v. (2014). DSM‐5 and ICD‐11 definitions of posttraumatic stress disorder: Investigating “narrow” and “broad” approaches. Depress & Anxiety, 31(6), 494-505.
Available at: https://ecommons.aku.edu/eastafrica_fhs_mc_intern_med/180