The Impact of the New ICD-11 Criteria on Abused Young People: 30% Less PTSD and CPTSD Diagnoses Compared to DSM-IV

IV, DSM-5, ICD-10, and ICD-11 and focuses on PTSD and CPTSD in a treatment-seeking sample of abused young people. Data were used from two clinical trials in Germany [7, 8]. All 83 participants (71 female), aged 14–21 years (mean = 17.65, SD = 2.26), suffered from PTSD according to DSM-IV after experiencing childhood sexual or physical abuse. The majority (74%) of the participants had experienced multiple traumatic events, and 76% reported more than one perpetrator. Regarding trauma type, the most distressing event was sexual abuse for 56% and physical abuse for 44% of the patients. Data were collected before treatment with clinical interviews and self-rating questionnaires (more details in the online suppl. material; for all online suppl. material, see www. karger.com/doi/10.1159/000503794). First, we calculated PTSD prevalence according to DSM-5, ICD-10, and ICD-11 criteria. For ICD-11 PTSD and CPTSD, we used selected items from the gold-standard interview Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA [9]), the self-report measures University of California at Los Angeles PTSD Reaction Index (UCLA [10]) and the Borderline Symptom List (BSL-23 [11]; see online suppl. Table S1). In accordance with the ICD-11 algorithm [1], patients were diagnosed with either PTSD or CPTSD. For DSM-5 and ICD-10, we used selected items from CAPS-CA. When applying the DSM-5, ICD-10, and ICD-11 criteria, prevalence rates decreased compared to DSM-IV (Table 1). The lowest rates were found for ICD-11 PTSD. In total, 34% of the young people met neither ICD-11 PTSD nor CPTSD. Most patients failed ICD-11 diagnosis because they did not meet enough features specified as criteria in the hyperarousal cluster. Second, we calculated differences between ICD-11 diagnostic groups (PTSD, CPTSD, and no ICD-11 PTSD) for trauma-related variables and comorbid symptom severity using Mann-Whitney U and χ2 tests (more details in the online suppl.). Three significant differences were observed between no ICD-11 PTSD and CPTSD. The CPTSD group showed higher scores for dissociation (U = 334.50, p = 0.032), depression symptom severity (U = 298.00, p = 0.012), and number of comorbid diagnoses (U = 326.00, p = 0.012). Last, trauma-related variables and comorbid symptom severity variables were included as predictors in a multinomial logistic regression to assess their contribution to class membership. Of nine predictors, only depression symptom severity was associated with an increased likelihood of CPTSD class membership compared to no ICD-11 PTSD (OR = 0.93, p = 0.003, see online suppl. Table S3). Our finding of lower PTSD prevalence rates comparing ICD-11 to other diagnostic manuals is in line with current research [2, 3]. One-third of our study sample no longer fulfilled PTSD diagnosis, and most patients did not meet criteria due to missing features in the hyperarousal cluster despite reporting functional impairment. In ICD-11, this cluster consists of hypervigilance and startle reaction, whereas other diagnostic manuals allow for a greater variety of symptoms. ICD-11 criteria may miss some relevant PTSD symptoms for Dear Editor, The diagnostic criteria for posttraumatic stress disorder (PTSD) have been reformulated and narrowed for ICD-11 [1] to six core symptoms across the clusters re-experiencing, avoidance, and hyperarousal. In comparison, PTSD criteria in DSM-IV consist of sixteen symptoms across three clusters, in DSM-5 of twenty symptoms across four clusters, and in ICD-10 of thirteen symptoms across three clusters. The new ICD-11 diagnosis Complex PTSD (CPTSD) requires symptoms of PTSD and in addition disturbances of self-organization: affect dysregulation, negative self-concept, and interpersonal problems. Impairment represented in the disturbances of self-organization domains is not necessarily associated with trauma-related stimuli. CPTSD typically follows prolonged or multiple events, but diagnosis does not require a certain type and frequency of a traumatic event. To date, only few studies have investigated the impact of these changes to PTSD features on children and adolescents [2–5]. ICD11 criteria seem to be less sensitive than ICD-10, DSM-IV [2], and DSM-5 [3] or yield similar prevalence rates to DSM-IV and DSM5 [4]. For ICD-11 PTSD, the lowest prevalence rates were reported in the hyperarousal [2] or the re-experiencing clusters [2, 4]. Comparing ICD-11 PTSD and CPTSD, studies found evidence for two distinct disorders by performing latent class analysis, and reported a lower prevalence for the CPTSD class [5, 6]. So far, studies have focused on PTSD in two or three different diagnostic manuals [2–4]. ICD-11 PTSD and CPTSD have as yet only been compared twice: in a treatment-seeking sample with PTSD after miscellaneous traumatic events (7–17 years [5]), and in a community sample (14–24 years [6]). This study expands the comparison of prevalence rates to four diagnostic manuals: DSMReceived: May 7, 2019 Accepted after revision: September 29, 2019 Published online: October 23, 2019