DSM-5 and ICD-11 definitions of posttraumatic stress disorder: Investigating "narrow" and "broad" approaches

Dan J. Stein, Katie A. McLaughlin, Karestan C. Koenen, Lukoye Atwoli, Matthew J. Friedman, Eric D. Hill, Andreas Maercker, Maria Petukhova, Victoria Shahly, Mark Van Ommeren, Jordi Alonso, Guilherme Borges, Giovanni De Girolamo, Peter De Jonge, Koen Demyttenaere, Silvia Florescu, Elie G. Karam, Norito Kawakami, Herbert Matschinger, Michail OkoliyskiJose Posada-Villa, Kate M. Scott, Maria Carmen Viana, Ronald C. Kessler

Research output: Contribution to journalArticlepeer-review

152 Citations (Scopus)


Background: The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. Methods: WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSMIV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. Results: A total of 5.6% of respondents met criteria for "broadly defined" PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. Conclusions: These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies.

Original languageEnglish
Pages (from-to)494-505
Number of pages12
JournalDepression and Anxiety
Issue number6
Publication statusPublished - Jun 2014
Externally publishedYes


  • DSM-5
  • DSM-IV
  • Epidemiology
  • ICD-10
  • ICD-11
  • Nosology
  • Posttraumatic stress disorder
  • World mental health surveys


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