Comparison of DSM-IV and proposed ICD-11 formulations of PTSD among civilian survivors of war and war veterans - summary of an article by Morina et al. (2014)

Comparison of DSM-IV and proposed ICD-11 formulations of PTSD among civilian survivors of war and war veterans
Morina, N., Van Emmerik, A.A.P., Andrews, B., & Brewin, C.R. (2014).
Journal of Traumatic Stress, 27, 647-654

Introduction

Proposals for the ICD-11 have included a reduction and simplification in the symptoms required for a PTSD diagnosis. An proposed innovation involves specifying core elements rather than typical features of PTSD. Core elements are those that on empirical or theoretical grounds most clearly distinguish PTSD from other disorders.

Core elements consist of: 1) re-experiencing the traumatic event(s) in the present, a evidenced by either flashbacks or nightmares, accompanied by fear or horror. Flashbacks are intrusive waking memories in which re-experiencing in the present can vary from a transient sensation to a complete disconnection from the current environment. 2) Avoidance of intrusions, evidenced by marked internal avoidance of thoughts and memories, or external avoidance of activities or situations 3) Excessive sense of current threat, evidenced by hypervigilane or exaggerated startle.

PTSD is defined in terms of the presence of at least one of the two symptoms of each of these core elements. In addition there must be impairment in functioning.

Findings

The new approach proposed for ICD-11 need not make a substantial difference to PTSD prevalence.

The 17 symptoms described in the DSM-IV are not all required to access PTSD.

More individuals meet the avoidance criterion in the ICD-11 system.

The reduced set of symptoms led to less comorbidity.