Updated PTSD criteria from DSM-5 as compared to DSM-IV criteria
1. The percentage of soldiers that met the symptom criteria for post-traumatic stress disorder (PTSD) using the new DSM-5 was equivalent to the percentage that met the criteria according to the previous DSM-IV-TR.
2. A discordance between the two sets of criteria existed as 30% of the soldiers who met the DSM-5 criteria did not meet the DSM-IV criteria and an equivalent percentage who met the DSM-IV criteria did not meet the DSM-5 criteria.
Evidence Rating Level: 2 (Good)
Study Rundown: With the transition from the DSM-IV-TR to DSM-5, many criteria for the most common mental disorders remained unchanged, while the definition of PTSD included significant changes in order to enhance diagnostic accuracy and clinical utility. Some changes included moving PTSD from anxiety disorders to a separate chapter relating to trauma and stress disorders, adding three new symptoms to the original 17 symptoms, and rewording many of the original symptoms. This study sought to compare directly the new 20-item PTSD checklist (PCL-5) using the DSM-5 to the original 17-item PTSD checklist (PCL-S) from DSM-IV-TR through an anonymous survey in a population of infantry soldiers including nearly half with combat experience in Iraq or Afghanistan.
The results showed that overall, a similar percentage of soldiers, including those with combat experience, met the criteria for PTSD based on DSM-5 as those who met DSM-IV criteria. However, a large percentage who met DSM-IV-TR criteria did not also meet DSM-5 criteria, and vice versa. Limitations of the study included not having a structured diagnostic interview to compare the results to and not being able to study the effects of changes to certain PTSD criteria. This study was strengthened by having a large population as well as the randomized design to minimize test-retest bias. The authors concluded that although the results comparing the original DSM-IV-TR to the new DSM-5 criteria were nearly identical, there was a measurable amount of disagreement in the results, suggesting that the new criteria may not have a greater clinical utility.
This study was funded by the US Army Military Operational Medicine Research Program (MOMRP), Fort Detrick, MD.
Click to read the study, published today in The Lancet Psychiatry
Relevant Reading: DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses
In-Depth [cross-sectional study]: 1,822 US infantry soldiers were included in the study, including 946 with combat experience in Iraq or Afghanistan. The goals of the study were to assess whether the prevalence of PTSD symptom criteria differed in both versions, how many soldiers met criteria in one version but not the other, how wording changes affected symptom reporting, if the new criteria offered greater clinical utility, and how the score distributions compared in both versions. Participants were administered a survey covering demographics, deployment history, combat experiences, mental health, and functioning. Two versions of the survey were randomly administered with either the original PCL-S on page four, followed by PCL-5 two pages later (survey A, n=911), or PCL-5 on page four, followed by PCL-S two pages later (survey B, n=911).
The percentages of soldiers who met criteria for PTSD using DSM-IV-TR were similar to those who met criteria using DSM-5 in both the total study population and combat experience group. 224 total soldiers (13%) were positive based on DSM-IV-TR and 216 (12%) were positive based on DSM-5 (k=0.67). In the group with combat experience, 177 (19%) were positive based on DSM-IV-TR and 165 (18%) were positive based on DSM-5 (k=0.66). However, there was a disagreement in the results as 67 of 221 (30%) soldiers met criteria using DSM-IV-TR but not DSM-5, 59 of 213 (28%) met criteria using DSM-5 criteria but not DSM-IV-TR, and 154 met both criteria. Additionally, PCL-5 and PCL-S showed identical reliabilities. There was substantial agreement in the reporting of individual symptoms (k>0.60 for 16 of 17 symptoms) but no significant differences in prevalence or severity of symptoms.
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