title: The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity.
abstract: The World Health Organization's posttraumatic stress disorder (PTSD) work group has published a proposal for the forthcoming edition of the International Classification of Diseases (ICD-11) that would yield a very different diagnosis relative to DSM-5. This study examined the impact of the proposed ICD-11 changes on PTSD prevalence relative to the ICD-10 and DSM-5 definitions and also evaluated the extent to which these changes would accomplish the stated aim of reducing the comorbidity associated with PTSD. Diagnostic prevalence estimates were compared using a U.S. national community sample and two U.S. Department of Veterans Affairs clinical samples. The ICD-11 definition yielded prevalence estimates 10-30% lower than DSM-5 and 25% and 50% lower than ICD-10 with no reduction in the prevalence of common comorbidities. Findings suggest that by constraining the diagnosis to a narrower set of symptoms, the proposed ICD-11 criteria set would substantially reduce the number of individuals with the disorder. These findings raise doubt about the extent to which the ICD-11 proposal would achieve the aim of reducing comorbidity associated with PTSD and highlight the public health and policy implications of such a redefinition.
authors.affiliation: Department of Psychology, University of North Carolina at Greensboro, UNCG Psychology, PO Box 26170, Greensboro, NC 27402, USA. Electronic address: bewisco@uncg.edu.
authors.forename: Blair E
authors.initials: BE
authors.lastname: Wisco
authors.affiliation: National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, 150 South Huntington Avenue, Boston, MA 02130, USA. Electronic address: Mark.Miller5@va.gov.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Miller
authors.affiliation: National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, 150 South Huntington Avenue, Boston, MA 02130, USA. Electronic address: Erika.Wolf@va.gov.
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Wolf
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina at Charleston, 67 President Stress, MSC 861, Charleston, SC 29425, USA. Electronic address: kilpatdg@musc.edu.
authors.forename: Dean
authors.initials: D
authors.lastname: Kilpatrick
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina at Charleston, 67 President Stress, MSC 861, Charleston, SC 29425, USA. Electronic address: resnickh@musc.edu.
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Resnick
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina at Charleston, 67 President Stress, MSC 861, Charleston, SC 29425, USA. Electronic address: christal.badour@uky.edu.
authors.forename: Christal L
authors.initials: CL
authors.lastname: Badour
authors.affiliation: National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, 150 South Huntington Avenue, Boston, MA 02130, USA. Electronic address: Brian.Marx@va.gov.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marx
authors.affiliation: National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, 150 South Huntington Avenue, Boston, MA 02130, USA. Electronic address: Terry.Keane@va.gov.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Keane
authors.affiliation: New England Research Institutes, 480 Pleasant Street, Watertown, MA 02472, USA. Electronic address: RRosen@neriscience.com.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.affiliation: VA National Center for PTSD, Departments of Psychiatry and Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, National Center for PTSD, VA Medical Center (116D), 215 North Main Street, White River Junction, VT 05009, USA. Electronic address: matthew.friedman@va.gov.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000145:classification* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D055815:Young Adult
keywords: DSM-5; Diagnosis; Diagnostic criteria; ICD-11; PTSD; Trauma