Cody G. Dodd, Claire L. Kirk, Paul J. Rathouz, James Custer, Amy S. Garrett, Leslie Taylor, Justin F. Rousseau, Cynthia Claasen, Myesha M. Morgan, D. Jeffrey Newport, Karen D. Wagner, Charles B. Nemeroff
{"title":"Comparing diagnostic criteria for posttraumatic stress disorder in a diverse sample of trauma-exposed youth","authors":"Cody G. Dodd, Claire L. Kirk, Paul J. Rathouz, James Custer, Amy S. Garrett, Leslie Taylor, Justin F. Rousseau, Cynthia Claasen, Myesha M. Morgan, D. Jeffrey Newport, Karen D. Wagner, Charles B. Nemeroff","doi":"10.1002/jts.23037","DOIUrl":null,"url":null,"abstract":"<p>Divergent conceptualization of posttraumatic stress disorder (PTSD) within the <i>Diagnostic and Statistical Manual of Mental Disorders</i> (5th ed.; <i>DSM-</i>5) and <i>International Statistical Classification of Diseases and Related Health Problems</i> (11th ed..; <i>ICD-11</i>) significantly confounds both research and practice. Using a diverse sample of trauma-exposed youth (<i>N</i> = 1,542, age range: 8–20 years), we compared these two diagnostic approaches along with an expanded version of the <i>ICD-11</i> PTSD criteria that included three additional reexperiencing symptoms (<i>ICD-11</i>+). Within the sample, PTSD was more prevalent using the <i>DSM-5</i> criteria (25.7%) compared to the <i>ICD-11</i> criteria (16.0%), with moderate agreement between these diagnostic systems, κ = .57. The inclusion of additional reexperiencing symptoms (i.e., <i>ICD-11</i>+) reduced this discrepancy in prevalence (24.7%) and increased concordance with <i>DSM-5</i> criteria, κ = .73. All three PTSD classification systems exhibited similar comorbidity rates with major depressive episode (MDE) or generalized anxiety disorder (GAD; 78.0%–83.6%). Most youths who met the <i>DSM-5</i> PTSD criteria also met the criteria for <i>ICD-11</i> PTSD, MDE, or GAD (88.4%), and this proportion increased when applying the <i>ICD-11</i>+ criteria (95.5%). Symptom-level analyses identified reexperiencing/intrusions and negative alterations in cognition and mood symptoms as primary sources of discrepancy between the <i>DSM-5</i> and <i>ICD-11</i> PTSD diagnostic systems. Overall, these results challenge assertions that nonspecific distress and diagnostically overlapping symptoms within <i>DSM-5</i> PTSD inflate comorbidity with depressive and anxiety disorders. Further, they support the argument that the <i>DSM-5</i> PTSD criteria can be refined and simplified without reducing the overall prevalence of psychiatric diagnoses in youth.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 4","pages":"606-616"},"PeriodicalIF":2.4000,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of traumatic stress","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jts.23037","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
Abstract
Divergent conceptualization of posttraumatic stress disorder (PTSD) within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and International Statistical Classification of Diseases and Related Health Problems (11th ed..; ICD-11) significantly confounds both research and practice. Using a diverse sample of trauma-exposed youth (N = 1,542, age range: 8–20 years), we compared these two diagnostic approaches along with an expanded version of the ICD-11 PTSD criteria that included three additional reexperiencing symptoms (ICD-11+). Within the sample, PTSD was more prevalent using the DSM-5 criteria (25.7%) compared to the ICD-11 criteria (16.0%), with moderate agreement between these diagnostic systems, κ = .57. The inclusion of additional reexperiencing symptoms (i.e., ICD-11+) reduced this discrepancy in prevalence (24.7%) and increased concordance with DSM-5 criteria, κ = .73. All three PTSD classification systems exhibited similar comorbidity rates with major depressive episode (MDE) or generalized anxiety disorder (GAD; 78.0%–83.6%). Most youths who met the DSM-5 PTSD criteria also met the criteria for ICD-11 PTSD, MDE, or GAD (88.4%), and this proportion increased when applying the ICD-11+ criteria (95.5%). Symptom-level analyses identified reexperiencing/intrusions and negative alterations in cognition and mood symptoms as primary sources of discrepancy between the DSM-5 and ICD-11 PTSD diagnostic systems. Overall, these results challenge assertions that nonspecific distress and diagnostically overlapping symptoms within DSM-5 PTSD inflate comorbidity with depressive and anxiety disorders. Further, they support the argument that the DSM-5 PTSD criteria can be refined and simplified without reducing the overall prevalence of psychiatric diagnoses in youth.
期刊介绍:
Journal of Traumatic Stress (JTS) is published for the International Society for Traumatic Stress Studies. Journal of Traumatic Stress , the official publication for the International Society for Traumatic Stress Studies, is an interdisciplinary forum for the publication of peer-reviewed original papers on biopsychosocial aspects of trauma. Papers focus on theoretical formulations, research, treatment, prevention education/training, and legal and policy concerns. Journal of Traumatic Stress serves as a primary reference for professionals who study and treat people exposed to highly stressful and traumatic events (directly or through their occupational roles), such as war, disaster, accident, violence or abuse (criminal or familial), hostage-taking, or life-threatening illness. The journal publishes original articles, brief reports, review papers, commentaries, and, from time to time, special issues devoted to a single topic.