Skip to main content
SpringerLink
Log in

Comparing the dimensional structure and diagnostic algorithms between DSM-5 and ICD-11 PTSD in children and adolescents

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

In contrast to the DSM-5, which expanded the posttraumatic stress disorder (PTSD) symptom profile to 20 symptoms, a workgroup of the upcoming ICD-11 suggested a reduced symptom profile with six symptoms for PTSD. Therefore, the objective of the study was to investigate the dimensional structure of DSM-5 and ICD-11 PTSD in a clinical sample of trauma-exposed children and adolescents and to compare the diagnostic rates of PTSD between diagnostic systems. The study sample consisted of 475 self-reports and 424 caregiver-reports on the child and adolescent trauma screen (CATS), which were collected at pediatric mental health clinics in the US, Norway and Germany. The factor structure of the PTSD construct as defined in the DSM-5 and in alternative models of both DSM-5 and ICD-11 was investigated using confirmatory factor analyses (CFA). To evaluate differences in PTSD prevalence, McNemar’s tests for correlated proportions were used. CFA results demonstrated excellent model fit for the proposed ICD-11 model of PTSD. For the DSM-5 models we found the best fit for the hybrid model. Diagnostic rates were significantly lower according to ICD-11 (self-report: 23.4%; caregiver-report: 16.5%) compared with the DSM-5 (self-report: 37.8%; caregiver-report: 31.8%). Agreement was low between diagnostic systems. Study findings provide support for an alternative latent dimensionality of DSM-5 PTSD in children and adolescents. The conceptualization of ICD-11 PTSD shows an excellent fit. Inconsistent PTSD constructs and significantly diverging diagnostic rates between DSM-5 and the ICD-11 will result in major challenges for researchers and clinicians in the field of psychotraumatology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Arlington, American Psychiatric Association

    Book  Google Scholar 

  2. Friedman MJ, Resick PA, Bryant RA, Brewin CR (2011) Considering PTSD for DSM-5. Depress Anxiety 28:750–769

    Article  PubMed  Google Scholar 

  3. Hansen M, Hyland P, Armour C, Shevlin M, Elklit A (2015) Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples. Eur J Psychotraumatol. doi:10.3402/ejpt.v6.28766

    Google Scholar 

  4. Soberon C, Crespo M, del Mar Gomez-Gutierrez M, Fernandez-Lansac V, Armour C (2016) Dimensional structure of DSM-5 posttraumatic stress symptoms in Spanish trauma victims. Eur J Psychotraumatol. doi:10.3402/ejpt.v7.32078

    PubMed  PubMed Central  Google Scholar 

  5. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL (2015) The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress 28:489–498

    Article  PubMed  Google Scholar 

  6. Armour C, Contractor A, Shea T, Elhai JD, Pietrzak RH (2016) Factor structure of the PTSD Checklist for DSM-5: relationships among symptom clusters, anger, and impulsivity. J Nerv Ment Dis 204:108–115

    Article  PubMed  Google Scholar 

  7. Armour C, Tsai J, Durham TA, Charak R, Biehn TL, Elhai JD, Pietrzak RH (2015) Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid anhedonia and externalizing behaviors model. J Psychiatry Res 61:106–113

    Article  Google Scholar 

  8. Pietrzak RH, Tsai J, Armour C, Mota N, Harpaz-Rotem I, Southwick SM (2015) Functional significance of a novel 7-factor model of DSM-5 PTSD symptoms: results from the National Health and Resilience in Veterans study. J Affect Disord 174:522–526

    Article  PubMed  Google Scholar 

  9. Liu L, Wang L, Cao C, Qing Y, Armour C (2016) Testing the dimensional structure of DSM-5 posttraumatic stress disorder symptoms in a nonclinical trauma-exposed adolescent sample. J Child Psychol Psychiatry 57:204–212

    Article  PubMed  Google Scholar 

  10. Wang L, Zhang L, Armour C, Cao C, Qing Y, Zhang J, Liu P, Zhang B, Wu Q, Zhao Z, Fan G (2015) Assessing the underlying dimensionality of DSM-5 PTSD symptoms in Chinese adolescents surviving the 2008 Wenchuan earthquake. J Anxiety Disord 31:90–97

    Article  PubMed  Google Scholar 

  11. Cao X, Wang L, Cao C, Zhang J, Elhai JD (2016) DSM-5 posttraumatic stress disorder symptom structure in disaster-exposed adolescents: stability across gender and relation to behavioral problems. J Abnorm Child Psychol 57(2):1–12

    Google Scholar 

  12. Armour C, Müllerova J, Elhai JD (2016) A systematic literature review of PTSD’s latent structure in the diagnostic and statistical manual of mental disorders: DSM-IV to DSM-5. Clin Psychol Rev 44:60–74

    Article  PubMed  Google Scholar 

  13. Maercker A, Brewin CR, Bryant RA, Cloitre M, Ommeren M, Jones LM, Humayan A, Kagee A, Llosa AE, Rousseau C (2013) Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry 12:198–206

    Article  PubMed  PubMed Central  Google Scholar 

  14. Forbes D, Lockwood E, Creamer M, Bryant RA, McFarlane AC, Silove D, Nickerson A, O’Donnell M (2015) Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: implications for the diagnostic algorithm. Br J Psychiatry 206:245–251

    Article  PubMed  Google Scholar 

  15. Haravuori H, Kiviruusu O, Suomalainen L, Marttunen M (2016) An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: factor analysis and comparisons to ICD-10 and DSM-IV. BMC Psychiatry 16(1):1–10

    Article  Google Scholar 

  16. Glück TM, Knefel M, Tran US, Lueger-Schuster B (2016) PTSD in ICD-10 and proposed ICD-11 in elderly with childhood trauma: prevalence, factor structure, and symptom profiles. Eur J Psychotraumatol. doi:10.3402/ejpt.v7.29700

    PubMed  PubMed Central  Google Scholar 

  17. Armour C (2014) The underlying dimensionality of PTSD in the diagnostic and statistical manual of mental disorders: where are we going? Eur J Psychotraumatol. doi:10.3402/ejpt.v6.28074

    Google Scholar 

  18. Galatzer-Levy IR, Bryant RA (2013) 636,120 ways to have posttraumatic stress disorder. Perspect Psychol Sci 8:651–662

    Article  PubMed  Google Scholar 

  19. Tay AK, Rees S, Chen J, Kareth M, Silove D (2015) The structure of post-traumatic stress disorder and complex post-traumatic stress disorder amongst West Papuan refugees. BMC Psychiatry 15:111

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hyland P, Shevlin M, McNally S, Murphy J, Hansen M, Elklit A (2016) Exploring differences between the ICD-11 and DSM-5 models of PTSD: does it matter which model is used? J Anxiety Disord 37:48–53

    Article  PubMed  Google Scholar 

  21. Wisco BE, Miller MW, Wolf EJ, Kilpatrick D, Resnick HS, Badour CL, Marx BP, Keane TM, Rosen RC, Friedman MJ (2016) The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity. Psychiatry Res 240:226–233

    Article  PubMed  PubMed Central  Google Scholar 

  22. O’Donnell ML, Alkemade N, Nickerson A, Creamer M, McFarlane AC, Silove D, Bryant RA, Forbes D (2014) Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11. Br J Psychiatry 205:230–235

    Article  PubMed  Google Scholar 

  23. Sachser C, Goldbeck L (2016) Consequences of the diagnostic criteria proposed for ICD-11 on the prevalence of PTSD in children and adolescents. J Trauma Stress 29:120–123

    Article  PubMed  Google Scholar 

  24. Danzi BA, La Greca AM (2016) DSM-IV, DSM-5, and ICD-11: identifying children with posttraumatic stress disorder after disasters. J Child Psychol Psychiatry 57:1444–1452

    Article  PubMed  Google Scholar 

  25. Hafstad GS, Thoresen S, Wentzel-Larsen T, Maercker A, Dyb G (2017) PTSD or not PTSD? Comparing the proposed ICD-11 and the DSM-5 PTSD criteria among young survivors of the 2011 Norway attacks and their parents. Psychol Med 47(7):1283–1291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sachser C, Berliner L, Holt T, Jensen TK, Jungbluth N, Risch E, Rosner R, Goldbeck L (2017) International development and psychometric properties of the child and adolescent trauma screen (CATS). J Affect Disord 210:189–195

    Article  PubMed  Google Scholar 

  27. Kline RB (2015) Principles and practice of structural equation modeling, 3rd edn. Guilford, New York

    Google Scholar 

  28. Muthen L, Muthen B (2012) Mplus user guide. Version 7. Statmodel, Los Angeles

    Google Scholar 

  29. Marsh HW, Hau KT, Balla JR, Grayson D (1998) Is more ever too much? The number of indicators per factor in confirmatory factor analysis. Multivar Behav Res 33:181–220

    Article  CAS  Google Scholar 

  30. Shevlin M, Hyland P, Karatzias T, Bisson JI, Roberts NP (2017) Examining the disconnect between psychometric models and clinical reality of posttraumatic stress disorder. J Anxiety Disord. doi:10.1016/j.janxdis.2017.02.006

    PubMed  Google Scholar 

  31. Brewin CR (2015) Re-experiencing traumatic events in PTSD: new avenues in research on intrusive memories and flashbacks. Eur J Psychotraumatol 6:27180

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all participating patients and caregivers, the study site directors and coordinators, assessors and research assistants.

Author information

Authors and Affiliations

  1. Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm Universtity, Steinhövelstraße 1, 89075, Ulm, Germany

    Cedric Sachser & Lutz Goldbeck

  2. Harborview Center for Sexual Assault and Traumatic Stress, Seattle, USA

    Lucy Berliner & Nathaniel Jungbluth

  3. Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway

    Tonje Holt & Tine Jensen

  4. Department of Psychology, University of Oslo, Oslo, Norway

    Tine Jensen

  5. Center on Child Abuse and Neglect, University of Oklahoma Health Sciences Center, Oklahoma City, USA

    Elizabeth Risch

  6. Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany

    Rita Rosner

  7. Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway

    Tonje Holt

Authors
  1. Cedric Sachser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucy Berliner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tonje Holt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tine Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nathaniel Jungbluth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elizabeth Risch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rita Rosner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lutz Goldbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cedric Sachser.

Ethics declarations

Ethical standards

The study had been approved by ethics committees at all participating sites. Informed assent of adolescents and informed consent of legal guardians were obtained before the assessment at the German and Norwegian sites. As the US sample was drawn from a retrospective collection of de-identified clinical data, a full IRB review was not required by the respective ethics committees. Therefore, the study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Details that might disclose the identity of the subjects under study have been omitted.

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 143 kb)

Supplementary material 2 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sachser, C., Berliner, L., Holt, T. et al. Comparing the dimensional structure and diagnostic algorithms between DSM-5 and ICD-11 PTSD in children and adolescents. Eur Child Adolesc Psychiatry 27, 181–190 (2018). https://doi.org/10.1007/s00787-017-1032-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-017-1032-9

Keywords

Search

Navigation