Differences between DSM-IV, DSM-5 PTSD criteria may lead to inaccuracies

TORONTO —Disparities between the DSM-IV and DSM-5 criteria for PTSD may lead to incomplete identification of military personnel who require trauma therapy, according to data presented at the American Psychiatric Association Annual Meeting.

“As you probably know, there were a lot of changes made in DSM-5. For most of the major disorders involving adults, there were not a lot of changes made with the exception of PTSD,” study researcher Charles W. Hoge, MD, of the Walter Reed Army Medical Center in Washington, D.C., said during his presentation. “This is the first major change in about 25 years of the definition’s existence. A1 criteria was changed, A2 criteria was eliminated and the three symptom clusters were divided into four symptom cluster, going from 17 symptoms to 20 symptoms.”

Charles W. Hoge

To assess differences between DSM-IV and DSM-5 criteria for PTSD and the potential implications of those differences, Hoge and colleagues surveyed 1,822 infantry soldiers from one brigade combat team, of whom 946 had been deployed to Iraq or Afghanistan. All surveys included the PTSD Checklist (PCL)-S and PCL-5.

Overall, the prevalence of meeting PTSD symptom criteria was similar for DSM-IV (12.9%) and DSM-5 (12.2%), as was the prevalence of individual symptom reporting. However, the analysis indicated 30% of soldiers who met DSM-IV criteria for PTSD did not meet DSM-5 criteria, and 28% who met DSM-5 criteria did not meet DSM-IV criteria.

The most common reason for meeting DSM-5 criteria but not meeting DSM-IV criteria was failing to meet the active avoidance symptom, or the new C-criteria.

“This is important for military service members because service members learn to override the A2 criteria, fear of helplessness or harm, and they also learn how to override avoidance symptoms as part of their training. We see many soldiers with high levels of symptomatology who are actually functioning quite well,” Hoge said. “If military service members have all three of the other criteria and are scoring high in every other regard but fail to meet the active avoidance symptom then technically they do not meet the new definition, but clearly there are individuals who need trauma therapy and would have meet the previous definition.”

Further analysis showed no significant differences in specificity or clinical utility of DSM-5 definitions vs. DSM-IV definitions.

“As I mentioned before, we see a lot of soldiers with very high levels of symptomatology that affects significant areas of their life, like social functioning, but they function very well in other settings, particularly occupationally. If you take those individuals who fail to meet avoidance criteria, what do you call them if they don’t meet the DSM-5 definition?” Hoge said. “I think clinicians today have some things they need to think about in terms of how they handle sub-thresholds.” – by Amanda Oldt

Reference:

Hoge CW, et al. Comparing DSM-IV and DSM-5 PTSD criteria in soldiers exposed to combat. Presented at: American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto.

Disclosure: Hoge reports no relevant financial disclosures.