Empirical Examination of a Proposed Refinement to DSM-IV Posttraumatic Stress Disorder Symptom Criteria Using the National Comorbidity Survey Replication Data
J Clin Psychiatry 2008;69(4):597-602
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Recently, changes have been proposed to DSM-IV
diagnostic criteria for posttraumatic stress disorder (PTSD) to refine the
diagnosis because of concerns about its construct validity. Specifically,
Spitzer et al. suggested narrowing the PTSD definition of trauma,
specifying a symptom onset time frame after the trauma, and removing symptoms
that overlap with other anxiety and mood disorders. We examined whether
removing these overlapping anxiety/mood disorder symptoms resulted in
differences (compared to the original DSM-IV PTSD criteria) in PTSD
prevalence rates, diagnostic caseness, comorbidity and mental health-related
disability, structural validity, and internal consistency.
Method: Cross-sectional data were examined from the National
Comorbidity Survey Replication (N = 5692), a multistage area household
probability sample of U.S. residents. PTSD diagnostic and symptom data and
diagnostic data for other Axis I disorders were taken from the Composite
International Diagnostic Interview. The study was conducted from February 2001
to December 2003.
Results: After removing PTSD symptoms overlapping with those
of other anxiety and mood disorders, we found that the lifetime PTSD prevalence
dropped only from 6.81% to 6.42%. Nevertheless, a sizeable proportion of PTSD-diagnosed
persons would consequently lose PTSD caseness. Little difference was found
between the criteria sets in diagnostic comorbidity and disability, structural
validity, and internal consistency.
Conclusions: These data provide evidence that PTSD's
overlapping anxiety and mood disorder symptoms are not responsible for PTSD's
prevalence, diagnostic comorbidity, and construct validity. Although the
proposed symptom criteria revision would result in fewer symptoms by which to
evaluate PTSD, it may not address questions raised about the diagnosis'