DSM-5 PTSD screening may miss previously diagnosed soldiers

Data published in The Lancet Psychiatry suggest a discordance between the previous version of the posttraumatic stress disorder definition in DSM-IV and the new version in DSM-5.

Charles W. Hoge, MD, of the center for psychiatry and neuroscience at the Walter Reed Army Institute of Research in Maryland, and colleagues evaluated 1,822 US soldiers, 946 of whom had been deployed to Iraq or Afghanistan, to compare the effectiveness of the new 20-item PTSD checklist (PCL), used for DSM-5, with the original 17-item specific stressor version (PCL-S). Participants received one of the two surveys, which were identical except for PCL version order.

Charles W. Hoge

Out of all participants, 13% screened positive for PTSD using DSM-IV criteria compared with 12% who screened positive using DSM-5 criteria. Similarly, among those exposed to combat, 19% screened positive using DSM-IV criteria compared with 18% who screened positive using DSM-5. However, 30% of 221 participants who met DSM-IV criteria did not meet DSM-5 criteria.

“After 12 years of war, and over 25 years of solid clinical and research experience with the previous definition, the reclassification of the PTSD diagnosis in DSM-5 presents concerns for the evaluation and treatment of service members and veterans who have served in Iraq and Afghanistan,” Hoge said in a press release. “Although we found that roughly the same percentage of soldiers met criteria for PTSD according to the two definitions, and the new PTSD screening tool was equivalent to the one we’ve used for many years, we also found that the two PTSD definitions did not identify the same individuals. The new definition also did not appear to have greater clinical utility than the previous one.”

In an accompanying editorial, Alexander C. McFarlane, MD, of the center for traumatic stress studies at the University of Adelaide in Australia, wrote that the new PTSD criteria may assume individuals tell more than they know.

“Hoge and colleagues’ findings draw attention to the hazards that these changes in diagnostic criteria will introduce in the administration of veterans’ benefits and access to care,” he wrote. “We think there should be a period of transition between legal use of DSM-IV and DSM-5 so that potential effects of these changes can be examined and that deserving individuals are not denied their legal rights. There is an obligation not to let this unintended consequence of a fashion of psychopathological formulation prevail.”

For more information:

Hoge CW. Lancet Psychiatry. 2014;doi:10.1016/S2215-0366(14)70235-4.

McFarlane AC. Lancet Psychiatry. 2014;doi:10.1016/S2215-0366(14)70321-9.

Disclosure: The study was funded in part by Fort Detrick MD, the Military Operational Medicine Research Program and the US Army.