Academic journal article European Journal of Psychotraumatology

Applicability of the ICD-11 Proposal for PTSD: A Comparison of Prevalence and Comorbidity Rates with the DSM-IV PTSD Classification in Two Post-Conflict Samples

Academic journal article European Journal of Psychotraumatology

Applicability of the ICD-11 Proposal for PTSD: A Comparison of Prevalence and Comorbidity Rates with the DSM-IV PTSD Classification in Two Post-Conflict Samples

Article excerpt

Responsible Editor: Chris Brewin, University College London, United Kingdom.

Copyright: © 2015 Nadine Stammel et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Received: 22 December 2014; Revised: 7 April 2015; Accepted: 8 April 2015; Published: 18 May 2015

Competing interests and funding: There is no conflict of interest in the present study for any of the authors. The studies were supported by grants of the German Federal Foreign Office and Psychology beyond Borders.

*Correspondence to: Nadine Stammel, Center for Torture Victims, Turmstr. 21, DE-10559 Berlin, Germany, Email: n.stammel@bzfo.de

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Three decades have now passed since the first definition of posttraumatic stress disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association [APA], 1980). Yet, the diagnosis is still the subject of considerable debate (Brewin, Lanius, Novac, Schnyder, & Galea, 2009). Recently, a proposal for the 11th edition of the International Classification of Diseases (ICD-11) was published with significant changes in the PTSD classification (Maercker et al., 2013). The ICD-11 will be relevant especially for low- to middle-income countries (Maercker et al., 2013). The Mental Health Gap Action Programme (mhGAP), which is aimed at improving mental health care in low- to middle-income countries, as well as World Health Organization projects dealing with mental health care in the context of humanitarian crises, will use the ICD-11 classification. For this reason, the developers of the ICD-11 placed great emphasis on its applicability for health professionals of different disciplines and across different clinical settings and regions of the world.

The ICD-11 reformulation was intended to respond to criticism of previous PTSD classifications based on the ICD-10 and DSM-IV, which have been criticized on three main grounds (Maercker et al., 2013). First, there has been concern about the overlap of PTSD symptoms with symptoms of depression and other anxiety disorders, such as loss of interest or irritability. A second major criticism of previous PTSD classifications concerns their potential overuse in populations exposed to extreme stressors such as natural and man-made disasters (Maercker et al., 2013; Summerfield, 2001). Critics argue that PTSD symptoms cannot be distinguished from common stress reactions in these populations. Especially, the ICD-10 has been criticized for not including a requirement of functional impairment, making the distinction between normal and pathological reactions to traumatic events difficult. A third criticism focused on the trauma criterion, which defines the range of events that can be considered traumatic (Brewin et al., 2009). It has been debated to what extent this criterion is too broadly defined, so that it includes almost any human experience and risks being meaningless, or too narrowly defined.

The ICD-11 reformulation for PTSD is based on a proposal put forward by Brewin et al. (2009). A complete overview of the proposal is given in the Appendix. The classification is composed of three criteria (re-experiencing, avoidance, and perceived current threat), each of them containing two symptoms (Maercker et al., 2013). For the diagnosis of PTSD, at least one symptom of each criterion needs to be present for the period of several weeks after the exposure to an "extremely threatening or horrific event or series of events" (Maercker et al. …

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