title: Network models of DSM-5 posttraumatic stress disorder: Implications for ICD-11.
abstract: Recent proposals for revisions to the 11th edition of theInternational Classification of Diseases(ICD-11) posttraumatic stress disorder (PTSD) diagnostic criteria have argued that the current symptom constellation under theDiagnostic and Statistical Manual of Mental Disorders-5is unwieldy and includes many symptoms that overlap with other disorders. The newly proposed criteria for theICD-11include only 6 symptoms. However, restricting the symptoms to those included in theICD-11has implications for PTSD diagnosis prevalence estimates, and it remains unclear whether these 6 symptoms are most strongly associated with a diagnosis of PTSD. Network analytic methods, which assume that psychiatric disorders are networks of interrelated symptoms, provide information regarding which symptoms are most central to a network. We estimated network models of PTSD in a national sample of veterans of the Iraq and Afghanistan wars. In the full sample, the most central symptoms were persistent negative emotional state, efforts to avoid external reminders, efforts to avoid thoughts or memories, inability to experience positive emotions, distressing dreams, and intrusive distressing thoughts or memories; that is, 3 of the 6 most central items to the network would be eliminated from the diagnosis under the current proposal forICD-11. An empirically defined index summarizing the most central symptoms in the network performed comparably to an index reflecting the proposedICD-11PTSD criteria at identifying individuals with an independently assessed DSM-5 defined PTSD diagnosis. Our results highlight the symptoms most central to PTSD in this sample, which may inform future diagnostic systems and treatment. (PsycINFO Database Record
authors.affiliation: National Center for PTSD, VA Boston Healthcare System.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Mitchell
authors.affiliation: National Center for PTSD, VA Boston Healthcare System.
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Wolf
authors.affiliation: National Center for PTSD, VA Boston Healthcare System.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Bovin
authors.affiliation: VA Boston Healthcare System, Research Service.
authors.forename: Lewina O
authors.initials: LO
authors.lastname: Lee
authors.affiliation: VA Boston Healthcare System, Research Service.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Green
authors.affiliation: New England Research Institutes.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.affiliation: National Center for PTSD, VA Boston Healthcare System.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Keane
authors.affiliation: National Center for PTSD, VA Boston Healthcare System.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marx
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D003627:Data Interpretation, Statistical; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D013313:Stress Disorders, Post-Traumatic / Q000145:classification* / Q000175:diagnosis*; D014728:Veterans