DSM-5 and ICD-11 definitions of posttraumatic stress disorder: Investigating "narrow" and "broad" approaches

Dan J. Stein, Katie A. McLaughlin, Karestan C. Koenen, Lukoye Atwoli, Matthew J. Friedman, Eric D. Hill, Andreas Maercker, Maria Petukhova, Victoria Shahly, Mark Van Ommeren, Jordi Alonso, Guilherme Borges, Giovanni De Girolamo, Peter De Jonge, Koen Demyttenaere, Silvia Florescu, Elie G. Karam, Norito Kawakami, Herbert Matschinger, Michail OkoliyskiJose Posada-Villa, Kate M. Scott, Maria Carmen Viana, Ronald C. Kessler

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)494-505
Number of pages12
JournalDepression and Anxiety
Volume31
Issue number6
DOIs
Publication statusPublished - 2014

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Post-Traumatic Stress Disorders
International Classification of Diseases
Diagnostic and Statistical Manual of Mental Disorders
Health Surveys
Mental Health
Fear
Surveys and Questionnaires
Interviews

Keywords

  • DSM-5
  • DSM-IV
  • Epidemiology
  • ICD-10
  • ICD-11
  • Nosology
  • Posttraumatic stress disorder
  • World mental health surveys

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology
  • Medicine(all)

Cite this

Stein, D. J., McLaughlin, K. A., Koenen, K. C., Atwoli, L., Friedman, M. J., Hill, E. D., ... Kessler, R. C. (2014). DSM-5 and ICD-11 definitions of posttraumatic stress disorder: Investigating "narrow" and "broad" approaches. Depression and Anxiety, 31(6), 494-505. https://doi.org/10.1002/da.22279

DSM-5 and ICD-11 definitions of posttraumatic stress disorder : Investigating "narrow" and "broad" approaches. / Stein, Dan J.; McLaughlin, Katie A.; Koenen, Karestan C.; Atwoli, Lukoye; Friedman, Matthew J.; Hill, Eric D.; Maercker, Andreas; Petukhova, Maria; Shahly, Victoria; Van Ommeren, Mark; Alonso, Jordi; Borges, Guilherme; De Girolamo, Giovanni; De Jonge, Peter; Demyttenaere, Koen; Florescu, Silvia; Karam, Elie G.; Kawakami, Norito; Matschinger, Herbert; Okoliyski, Michail; Posada-Villa, Jose; Scott, Kate M.; Viana, Maria Carmen; Kessler, Ronald C.

In: Depression and Anxiety, Vol. 31, No. 6, 2014, p. 494-505.

Research output: Contribution to journalArticle

Stein, DJ, McLaughlin, KA, Koenen, KC, Atwoli, L, Friedman, MJ, Hill, ED, Maercker, A, Petukhova, M, Shahly, V, Van Ommeren, M, Alonso, J, Borges, G, De Girolamo, G, De Jonge, P, Demyttenaere, K, Florescu, S, Karam, EG, Kawakami, N, Matschinger, H, Okoliyski, M, Posada-Villa, J, Scott, KM, Viana, MC & Kessler, RC 2014, 'DSM-5 and ICD-11 definitions of posttraumatic stress disorder: Investigating "narrow" and "broad" approaches', Depression and Anxiety, vol. 31, no. 6, pp. 494-505. https://doi.org/10.1002/da.22279
Stein, Dan J. ; McLaughlin, Katie A. ; Koenen, Karestan C. ; Atwoli, Lukoye ; Friedman, Matthew J. ; Hill, Eric D. ; Maercker, Andreas ; Petukhova, Maria ; Shahly, Victoria ; Van Ommeren, Mark ; Alonso, Jordi ; Borges, Guilherme ; De Girolamo, Giovanni ; De Jonge, Peter ; Demyttenaere, Koen ; Florescu, Silvia ; Karam, Elie G. ; Kawakami, Norito ; Matschinger, Herbert ; Okoliyski, Michail ; Posada-Villa, Jose ; Scott, Kate M. ; Viana, Maria Carmen ; Kessler, Ronald C. / DSM-5 and ICD-11 definitions of posttraumatic stress disorder : Investigating "narrow" and "broad" approaches. In: Depression and Anxiety. 2014 ; Vol. 31, No. 6. pp. 494-505.
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AU - Stein, Dan J.

AU - McLaughlin, Katie A.

AU - Koenen, Karestan C.

AU - Atwoli, Lukoye

AU - Friedman, Matthew J.

AU - Hill, Eric D.

AU - Maercker, Andreas

AU - Petukhova, Maria

AU - Shahly, Victoria

AU - Van Ommeren, Mark

AU - Alonso, Jordi

AU - Borges, Guilherme

AU - De Girolamo, Giovanni

AU - De Jonge, Peter

AU - Demyttenaere, Koen

AU - Florescu, Silvia

AU - Karam, Elie G.

AU - Kawakami, Norito

AU - Matschinger, Herbert

AU - Okoliyski, Michail

AU - Posada-Villa, Jose

AU - Scott, Kate M.

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