Jonathan D Green1,2, Anthony Annunziata1,2, Sarah E Kleiman1,2, Michelle J Bovin2,3, Aaron M Harwell1, Annie M L Fox1, Shimrit K Black1,2, Paula P Schnurr4,5, Darren W Holowka6,7, Raymond C Rosen8, Terence M Keane2,3, Brian P Marx2,3. 1. VA Boston Healthcare System, Boston, MA, USA. 2. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA. 3. National Center for PTSD at the VA Boston Healthcare System, Boston, MA, USA. 4. Executive Division, National Center for PTSD, White River Junction, VT, USA. 5. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. 6. Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA. 7. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University. 8. New England Research Institutes, Watertown, MA, USA.
Abstract
BACKGROUND: Posttraumatic stress disorder (PTSD) diagnostic criteria have been criticized for including symptoms that overlap with commonly comorbid disorders, which critics argue undermines the validity of the diagnosis and inflates psychiatric comorbidity rates. In response, the upcoming 11th edition of the International Classification of Diseases (ICD-11) will offer PTSD diagnostic criteria that are intended to promote diagnostic accuracy. However, diagnostic utility analyses have not yet assessed whether these criteria minimize diagnostic errors. The present study examined the diagnostic utility of each PTSD symptom in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for males and females. METHODS: Participants were 1,347 individuals enrolled in a longitudinal national registry of returning veterans receiving care at a Department of Veterans Affairs (VA) facility. Doctoral level clinicians assessed all participants using the PTSD module of the Structured Clinical Interview for DSM. RESULTS: Of the 20 symptoms examined, the majority performed in the fair to poor range on test quality indices. Although a few items did perform in the good (or better) range, only half were ICD-11 symptoms. None of the 20 symptoms demonstrated good quality of efficiency. Results demonstrated few sex differences across indices. There were no differences in the proportion of comorbid psychiatric disorders or functional impairment between DSM-5 and ICD-11 criteria. CONCLUSIONS: ICD-11 PTSD criteria demonstrate neither greater diagnostic specificity nor reduced rates of comorbidity relative to DSM-5 criteria and, as such, do not perform as intended. Modifications to existing symptoms or new symptoms may improve differential diagnosis.
BACKGROUND:Posttraumatic stress disorder (PTSD) diagnostic criteria have been criticized for including symptoms that overlap with commonly comorbid disorders, which critics argue undermines the validity of the diagnosis and inflates psychiatric comorbidity rates. In response, the upcoming 11th edition of the International Classification of Diseases (ICD-11) will offer PTSD diagnostic criteria that are intended to promote diagnostic accuracy. However, diagnostic utility analyses have not yet assessed whether these criteria minimize diagnostic errors. The present study examined the diagnostic utility of each PTSD symptom in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for males and females. METHODS:Participants were 1,347 individuals enrolled in a longitudinal national registry of returning veterans receiving care at a Department of Veterans Affairs (VA) facility. Doctoral level clinicians assessed all participants using the PTSD module of the Structured Clinical Interview for DSM. RESULTS: Of the 20 symptoms examined, the majority performed in the fair to poor range on test quality indices. Although a few items did perform in the good (or better) range, only half were ICD-11 symptoms. None of the 20 symptoms demonstrated good quality of efficiency. Results demonstrated few sex differences across indices. There were no differences in the proportion of comorbid psychiatric disorders or functional impairment between DSM-5 and ICD-11 criteria. CONCLUSIONS: ICD-11 PTSD criteria demonstrate neither greater diagnostic specificity nor reduced rates of comorbidity relative to DSM-5 criteria and, as such, do not perform as intended. Modifications to existing symptoms or new symptoms may improve differential diagnosis.
Keywords:
Diagnostic and Statistical Manual for Mental Disorders; International Classification of Diseases; diagnostic techniques and procedures; posttraumatic; psychological trauma; stress disorder
Authors: Yara Mekawi; Madison W Silverstein; Aisha Walker; Martha Ishiekwene; Sierra Carter; Vasiliki Michopoulos; Jennifer S Stevens; Abigail Powers Journal: J Anxiety Disord Date: 2022-03-10