Does size really matter? A multisite study assessing the latent structure of the proposed ICD-11 and DSM-5 diagnostic criteria for PTSD

Abstract

Background: Researchers and clinicians within the field of trauma have to choose between different diagnostic descriptions of posttraumatic stress disorder (PTSD) in the DSM-5 and the proposed ICD-11. Several studies support different competing models of the PTSD structure according to both diagnostic systems; however, findings show that the choice of diagnostic systems can affect the estimated prevalence rates. Objectives: The present study aimed to investigate the potential impact of using a large (i.e. the DSM-5) compared to a small (i.e. the ICD-11) diagnostic description of PTSD. In other words, does the size of PTSD really matter? Methods: The aim was investigated by examining differences in diagnostic rates between the two diagnostic systems and independently examining the model fit of the competing DSM-5 and ICD-11 models of PTSD across three trauma samples: university students (N = 4213), chronic pain patients (N = 573), and military personnel (N = 118). Results: Diagnostic rates of PTSD were significantly lower according to the proposed ICD-11 criteria in the university sample, but no significant differences were found for chronic pain patients and military personnel. The proposed ICD-11 three-factor model provided the best fit of the tested ICD-11 models across all samples, whereas the DSM-5 seven-factor Hybrid model provided the best fit in the university and pain samples, and the DSM-5 six-factor Anhedonia model provided the best fit in the military sample of the tested DSM-5 models. Conclusions: The advantages and disadvantages of using a broad or narrow set of symptoms for PTSD can be debated, however, this study demonstrated that choice of diagnostic system may influence the estimated PTSD rates both qualitatively and quantitatively. In the current described diagnostic criteria only the ICD-11 model can reflect the configuration of symptoms satisfactorily. Thus, size does matter when assessing PTSD.

Development and Evaluation of the Dutch Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

“…It can therefore not be excluded that with a BIC test the Anhedonia model would have had equal or better fit statistics compared to the Hybrid model in their data. Interestingly, Hansen et al (2017) found that the optimal factor structure of DSM-5 PTSD seems to depend on population. In their data the Hybrid model provided the best fit in a sample of university students and a sample of pain patients, while the Anhedonia model provided the best fit in a military sample.…”

Child maltreatment across the lifespan

“…(2017) provides an update of the conceptual structure and self-report measurement of PTSD and CPTSD using the International Trauma Questionnaire (ITQ), with a focus on selected studies from the USA, Germany, the UK, and Lithuania. Preliminary results suggest that CPTSD is common across the four countries in both clinical and general population samples, and that the ITQ can distinguish between PTSD and CPTSD (see also Hansen et al, 2017). Furthermore, the ITQ appears to be a reliable and valid measurement.…”

“…Specifically, in relation to PTSD, the Hansen et al (2017) study aims at investigating the potential impact of choosing one rather than the other diagnostic system across three distinct trauma samples ( N  = 4213). Results showed that although the only significant difference in the estimated prevalence rates was found in the university sample (i.e.…”

“…the Hybrid model and the Anhedonia model) provided the best fit of the data from the tested models of the latent structure of DSM-5 PTSD symptoms. Hansen et al (2017) discuss the implications of use of the two diagnostic systems, which is not straightforward as the estimated PTSD rates may be both qualitatively and quantitively influenced by this choice.…”

Psychotraumatology on the move

“…A multisite study assessing the latent structure of the proposed ICD-11 and DSM-5 diagnostic criteria for PTSD’ (Hansen et al, 2017). And this is not for the title that some of us found ‘intriguing’ but for its relevant and timely content, the importance of the comparison of two diagnostic systems and the use of three large samples ( N  = 4,213), the diversity of the samples (clinical, work related and community), the use of validated tools to measure both the ICD-11 and the DSM-5 PTSD symptoms, and the fact that both quantitative and qualitative differences in prevalence rates were investigated.…”