title: The impact of changing diagnostic criteria in posttraumatic stress disorder in a Canadian epidemiologic sample.
abstract: BACKGROUND
  Since its inclusion in DSM-III, posttraumatic stress disorder (PTSD) has undergone a number of changes in its diagnostic criteria, including the expansion of Criterion A (traumatic stressor), the addition of symptom duration (none specified in DSM-III), and the requirement for impairment or distress (Criterion F, DSM-IV only).
  
  
  METHODS
  This study examined the impact of changes in PTSD diagnostic criteria using a Canadian PTSD epidemiologic sample. The rates of PTSD and its correlates were evaluated in a nationally representative random sample of 3,006 adults. DSM-III, DSM-III-R, DSM-IV, and ICD-10 criteria were employed. DSM-III, DSM-III-R, and ICD-10 rates were re-evaluated, substituting specific DSM-IV criteria (A-F).
  
  
  RESULTS
  The prevalence rates of lifetime PTSD ranged from 13.4% (DSM-III) to 13.0% (ICD-10) to 12.2% (DSM-III-R) to 9.2% (DSM-IV); all rates differed significantly from each other (P < .001). Regardless of diagnostic criteria, most people reported more than 1-year duration of symptoms, although rates were significantly higher in those with DSM-IV PTSD (68.2%, P < .0001). Rates of comorbid major depressive disorder and alcohol and substance abuse and dependence were also significantly higher (P < .05) using the DSM-IV PTSD criteria, and those with DSM-IV PTSD reported significantly higher rates of help-seeking (P < .001). When Criterion F was added to earlier versions, lifetime PTSD rates became much closer to those obtained using DSM-IV criteria: 10.6% (DSM-III), 10.2% (DSM-III-R), and 9.9% (ICD-10); however, rates fluctuated when operational definitions of Criterion F were modified. DSM-III PTSD was also substantially affected by DSM-IV Criteria A and C.
  
  
  CONCLUSIONS
  DSM-IV PTSD may identify a more severe disorder. The addition of the clinical significance criterion (F) appeared to affect the greatest change in prevalence rates. Defining Criterion F as having both clinically significant psychological distress and functional impairment lowered the diagnostic threshold to a greater degree than did either distress or impairment alone. This information may be useful for future revisions of PTSD diagnostic criteria.
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, 439-1 Fontbonne Building, St Joseph's Healthcare Hamilton, 301 James St S, Hamilton, Ontario, Canada L8P 3B5. vanamer@mcmaster.ca
authors.forename: Michael
authors.initials: M
authors.lastname: Van Ameringen
authors.forename: Catherine
authors.initials: C
authors.lastname: Mancini
authors.forename: Beth
authors.initials: B
authors.lastname: Patterson
mesh_terms: D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007406:Interview, Psychological; D008016:Life Change Events; D009864:Ontario; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology