Testing the DSM-5 New Items and Algorithm Change for the Diagnosis of Posttraumatic Stress Disorder

Area of Science:

• Psychiatry
• Clinical Psychology
• Mental Health Research

Background:

• Concerns exist regarding the empirical foundation of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) revisions for posttraumatic stress disorder (PTSD).
• Previous research has assessed the overall impact of DSM-5 revisions on PTSD diagnostic rates.
• No study has individually evaluated the contribution of each specific criterion change to diagnostic frequency.

Purpose of the Study:

• To investigate the impact of individual DSM-5 PTSD criterion revisions on diagnostic frequency.
• To compare the diagnostic yield of different cluster structures within the DSM-5 criteria.
• To examine demographic associations with new PTSD symptom items.

Main Methods:

• Collected PTSD symptom data from child/parent reports (n=65) and adult patient reports (n=322) at mental health clinics.
• Compared PTSD diagnosis rates using DSM-IV criteria versus DSM-5 criteria with individual and combined new symptom additions.
• Analyzed diagnostic frequencies based on three-cluster versus four-cluster structures.

Main Results:

• For adults, adding negative beliefs, distorted thoughts, or reckless behavior did not significantly alter PTSD diagnosis rates compared to DSM-IV.
• The addition of persistent negative emotional state significantly, but with a small effect, increased adult PTSD diagnoses.
• A four-cluster structure diagnosed fewer individuals than a three-cluster structure; overall, DSM-5 diagnosed fewer adults but the same number of youth compared to previous criteria.

Conclusions:

• The DSM-5 revisions for PTSD have a limited impact on diagnostic rates for adults, with only persistent negative emotional state showing a significant increase.
• The findings suggest that the empirical basis for some DSM-5 PTSD revisions warrants further scrutiny.
• The study highlights potential issues with the DSM-5's impact on PTSD diagnosis, particularly concerning individual criterion contributions and cluster structures.