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Psychol Med DOI:10.1017/S0033291718001101

Clinical implications of the proposed ICD-11 PTSD diagnostic criteria.

Publication TypeJournal Article
Year of Publication2019
AuthorsBarbano, AC, van der Mei, WF, Bryant, RA, Delahanty, DL, deRoon-Cassini, TA, Matsuoka, YJ, Olff, M, Qi, W, Ratanatharathorn, A, Schnyder, U, Seedat, S, Kessler, RC, Koenen, KC, Shalev, AY
JournalPsychol Med
Date Published2019 Feb

BACKGROUND: Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events.

METHODS: The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months.

RESULTS: The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range -47.09% to -57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38-36.49% higher than those identified by ICD-10 criteria alone. The latter, however, had CAPS scores indicative of moderate PTSD. ICD-11 was associated with similar or higher rates of comorbid mood and anxiety disorders. Individuals identified by either ICD-10 or ICD-11 shortly after traumatic events had similar longitudinal course.

CONCLUSIONS: This study indicates that significantly fewer individuals would be diagnosed with PTSD using the proposed ICD-11 criteria. Though ICD-11 criteria identify more severe cases, those meeting ICD-10 but not ICD-11 criteria remain in the moderate range of PTSD symptoms. Use of ICD-11 criteria will have critical implications for case identification in clinical practice, national reporting, and research.


Alternate JournalPsychol Med
PubMed ID29754591
PubMed Central IDPMC6331687
Grant ListR01 MH101227 / MH / NIMH NIH HHS / United States