A Crosswalk Study of DSM-IV and DSM-5 Criteria for PTSD from the DSM-5 Field Trials

Abstract

Objective: Posttraumatic stress disorder (PTSD) is prevalent and sometimes severely disabling. Providing effective treatment for PTSD and addressing its social consequences require accurate diagnosis. PTSD criteria have changed in all editions of the American Diagnostic Criteria since introduction of the diagnosis in DSM-III in 1980. The DSM-5 Field Trials demonstrated very good inter-rater reliability for PTSD, but a crosswalk study comparing DSM-IV and DSM-5 criteria has potential to identify diagnostic differences generated by changed criteria. Methods: A DSM-IV to DSM-5 PTSD crosswalk study was conducted in real-world adult clinical treatment settings in two DSM-5 Field Trials sites, the Dallas (N = 93) and Houston (N = 48) Veterans Affairs medical centers. The crosswalk assessment was conducted by trained clinicians who interviewed the patients and rated both sets of criteria on a combined checklist. Results: PTSD prevalence differed insubstantially between criteria sets (42% vs. 45% and 55% vs. 52% in the Dallas and Houston sites, respectively), with moderate to excellent diagnostic agreement (reliability indicated, respectively, by κ = .53 and .93); however, substantial proportions of individuals diagnosed in one criteria set did not meet criteria in the other. Differences in cross-criteria diagnostic reliability were largely a function of differing definitions of criterion A trauma. Conclusions: Reliability across the two criteria sets was generally good to excellent, and diagnostic discrepancy predominantly reflected the elimination of criterion A2 in DSM-5 with a smaller contribution from changes to the avoidance and numbing criteria.

ACKNOWLEDGMENTS

We acknowledge the data collection contributions of the Houston VA site, Laura Marsh, Director.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DISCLAIMERS

The opinions and assertions expressed herein are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense.

The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions, or policies of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government.

DATA AVAILABILITY STATEMENT

Data for this study are not publicly available.

Additional information

Funding

This research was funded by the American Psychiatric Association and the U.S. Department of Veterans Affairs.

Notes on contributors

Carol S. North

Carol S. North serves as Medical Director of the Altshuler Center for Education & Research at Metrocare Services in Dallas, Texas. Holding The Nancy and Ray L. Hunt Chair in Crisis Psychiatry, she is a board-certified Professor with tenure in the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, Texas where she is Director of the Division of Trauma and Disaster. Dr. North completed medical school and residency training in psychiatry at Washington University School of Medicine in St. Louis, Missouri, followed by a NIMH postdoctoral fellowship and a Masters degree, both in psychiatric epidemiology, at the same institution. 

Alina M. Surís

Alina M. Surís is affiliated with the VA North Texas Health Care System and the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, Texas. She completed her MA and PhD degrees in Clinical Psychology at the University of Houston. She has served as President of the American Board of Professional Psychologists. 

Diana Clarke

Diana Clarke is an experienced epidemiologist, research statistician, and educator who serves as adjunct assistant professor of the Johns Hopkins Bloomberg School of Public Health in the Department of Mental Health in Baltimore, Maryland and Managing Director of Research in the Division of Research at the American Psychiatric Association American Psychiatric Association in Washington, DC. She received her MS and PhD degrees at the University of Toronto. 

Jayme M. Palka

Jayme M. Palka is a biostatistician who serves as instructor in the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, Texas. She received her PhD degree in research, measurement, & statistics at the University of North Texas. 

Lamyaa Yousif

Lamyaa Yousif is an epidemiologist who serves as Senior DSM Operations Manager and Research Associate in the Division of Research at the American Psychiatric Association in Washington, DC. She received her MD degree from Al-Nahrain University, College of Medicine in Baghdad, Iraq and her PhD and MS degrees in epidemiology from Johannes Gutenberg University in Mainz, Germany. 

Darrel A. Regier

Darrel A. Regier is a Senior Scientist at the Center for the Study of Traumatic Stress in the Henry M Jackson Foundation for the Advancement of Military Medicine, and Adjunct Professor in the Department of Psychiatry of the Uniformed Services University. He served as vice-chair of the American Psychiatric Association (APA) DSM-5 Task Force, and was the APA Research Director, and Director of the American Psychiatric Institute for Research and Education for 14 years–following a 25-year career as Research Director at the National Institute of Mental Health. Dr. Regier received his medical degree from the Indiana University School of Medicine, an MPH at the Harvard School of Public Health, and a psychiatry residency and research fellowship at the Massachusetts General Hospital in Boston, Massachusetts.