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

Abstract

Substantial concerns have been raised about the lack of an empirical basis for revisions made to the criteria for posttraumatic stress disorder (PTSD) in the DSM-5. Although researchers have examined the broader impact of these revisions on diagnostic prevalence, no study to date has examined the contribution of each individual revision. The current study sought to explore how each change in criteria and cluster structure affect frequency of PTSD diagnosis. Between July 2012 and October 2021, PTSD symptoms were collected at intake from child/parent reports (n = 65) at a pediatric mental health clinic and from adult patient reports (n = 322) at an outpatient mental health clinic. Compared to the frequency of PTSD diagnosis for adults based on DSM-IV criteria (73.6%), the frequency did not significantly increase with the addition of negative beliefs (74.8%), distorted thoughts (76.1%), and reckless or self-destructive behavior (74.2%), and increased significantly with a small effect with the addition of persistent negative emotional state (79.5%). The trend was similar for the youth sample across all new symptoms. A four-cluster structure diagnosed fewer individuals compared to a three-cluster structure across different sets of symptoms. The overall impact, however, was for DSM-5 to diagnose fewer adults but the same number of youths. Significant associations were found for age and sex with some new items. Findings add new concerns to the growing literature on problematic impacts of DSM-5 revisions to PTSD.

Keywords: DSM-5; PTSD; diagnosis; diagnostic criteria; posttraumatic stress disorder.