Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11

Abstract

The diagnostic systems performed in different ways in terms of current prevalence rates and levels of comorbidity with depression, but on other broad key indicators they were relatively similar. There was overlap between those with PTSD diagnosed by ICD-11 and DSM-5 but a substantial portion met one but not the other set of criteria. This represents a challenge for research because the phenotype that is studied may be markedly different according to the diagnostic system used.

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).…”

“…The majority of publications comparing DSM-IV to DSM-5 report no differences (Carmassi et al, 2013; Elhai, Ford, Ruggiero, & Christopher Frueh, 2009; Elhai et al, 2012; Gentes et al, 2014; Kilpatrick et al, 2013; Miller et al, 2013; O’Donnell et al, 2014), with the exception of Forbes et al (2011) who found lower PTSD prevalence under DSM-5. Of those who reported consistency (Carmassi et al, 2013; Elhai et al, 2009; Gentes et al, 2014; Kilpatrick et al, 2013), all reported satisfying high agreement between both versions of the DSM.…”

“…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). …”