Comparing diagnostic criteria for posttraumatic stress disorder in a diverse sample of trauma‐exposed youth

Abstract

AbstractDivergent 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.