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DSM-5 AND ICD-11 DEFINITIONS OF POSTTRAUMATIC STRESS DISORDER: INVESTIGATING “NARROW” AND “BROAD” APPROACHES

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  • Contract grant sponsor: United States National Institute of Mental Health; Contract grant number: R01MH070884; Contract grant sponsor: John D. and Catherine T. MacArthur Foundation; Contract grant sponsor: The Pfizer Foundation; Contract grant sponsor: The US Public Health Service; Contract grant numbers: R13-MH066849, R01-MH069864, R01-MH092526, and R01-DA016558; Contract grant sponsor: Fogarty International Center; Contract grant number: FIRCA R03-TW006481; Contract grant sponsor: The Pan American Health Organization; Contract grant sponsor: the Eli Lilly & Company Foundation; Contract grant sponsor: Ortho-McNeil Pharmaceutical, Inc.; Contract grant sponsor: GlaxoSmithKline; Contract grant sponsor: Bristol-Myers Squibb; Contract grant sponsor: Shire Pharmaceuticals; Contract grant sponsor: State of São Paulo Research Foundation (FAPESP) Thematic Project; Contract grant number: 03/00204–3; Contract grant sponsor: European Commission; Contract grant numbers: QLG5–1999–01042 and SANCO 2004123; Contract grant sponsor: The Piedmont Region; Contract grant sponsor: Fondo de Investigación Sanitaria; Contract grant sponsor: Instituto de Salud Carlos III; Contract grant number: FIS 00/0028; Contract grant sponsor: Ministerio de Ciencia y Tecnología, Spain; Contract grant number: SAF 2000–158-CE; Contract grant sponsor: Departament de Salut, Generalitat de Catalunya; Contract grant sponsor: Instituto de Salud Carlos III; Contract grant numbers: CIBER CB06/02/0046 and RETICS RD06/0011 REM-TAP; Contract grant sponsor: Japan Ministry of Health, Labour and Welfare; Contract grant numbers: H13-SHOGAI-023, H14-TOKUBETSU-026, and H16-KOKORO-013; Contract grant sponsor: National Institute of Health/Fogarty International Center; Contract grant number: R03 TW006481–01; Contract grant sponsor: Astra Zeneca; Contract grant sponsor: Hikma Pharm; Contract grant sponsor: Janssen Cilag; Contract grant sponsor: MSD; Contract grant sponsor: Novartis; Contract grant sponsor: Sanofi Aventis; Contract grant sponsor: Servier; Contract grant sponsor: The National Institute of Psychiatry Ramon de la Fuente; Contract grant number: INPRFMDIES 4280; Contract grant sponsor: National Council on Science and Technology; Contract grant number: CONACyT-G30544-H; Contract grant sponsor: Health & Social Care Research & Development Division; Contract grant sponsor: Champalimaud Foundation; Contract grant sponsor: Gulbenkian Foundation; Contract grant sponsor: Foundation for Science and Technology (FCT); Contract grant sponsor: Ministry of Health; Contract grant sponsor: Ministry of Public Health (former Ministry of Health); Contract grant sponsor: National Institute of Mental Health (NIMH); Contract grant number: U01-MH60220.

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.

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