title: DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating "narrow" and "broad" approaches.
abstract: BACKGROUND
  The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10.
  
  
  METHODS
  WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSM-IV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems.
  
  
  RESULTS
  A total of 5.6% of respondents met criteria for "broadly defined" PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems.
  
  
  CONCLUSIONS
  These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies.
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.forename: Katie A
authors.initials: KA
authors.lastname: McLaughlin
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
authors.forename: Lukoye
authors.initials: L
authors.lastname: Atwoli
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
authors.forename: Eric D
authors.initials: ED
authors.lastname: Hill
authors.forename: Andreas
authors.initials: A
authors.lastname: Maercker
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.forename: Victoria
authors.initials: V
authors.lastname: Shahly
authors.forename: Mark
authors.initials: M
authors.lastname: van Ommeren
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Guilherme
authors.initials: G
authors.lastname: Borges
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.forename: Koen
authors.initials: K
authors.lastname: Demyttenaere
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.forename: Elie G
authors.initials: EG
authors.lastname: Karam
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
authors.forename: Herbert
authors.initials: H
authors.lastname: Matschinger
authors.forename: Michail
authors.initials: M
authors.lastname: Okoliyski
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.forename: Kate M
authors.initials: KM
authors.lastname: Scott
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000569:Americas / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005060:Europe / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D038801:International Classification of Diseases; D007564:Japan / Q000453:epidemiology; D008016:Life Change Events; D009520:New Zealand / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology*
keywords: DSM-IV; DSM-5; ICD-10; ICD-11; Posttraumatic stress disorder; World Mental Health Surveys; epidemiology; nosology