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      Does size really matter? A multisite study assessing the latent structure of the proposed ICD-11 and DSM-5 diagnostic criteria for PTSD Translated title: ¿El tamaño importa realmente? Un estudio multicentro que evalúa la estructura latente de la CIE-11 propuesta y los criterios diagnósticos del DSM-5 para el TEPT Translated title: 标题:症状数量重要吗? 一个评估ICD-11提案和DSM-5 PTSD诊断标准的潜在结构的多站点研究


      , , , , , , , , , ,

      European Journal of Psychotraumatology

      Taylor & Francis

      PTSD, DSM-5, ICD-11, CFA, diagnosis, TEPT, DSM-5, CIE-11, CFA, DIAGNÓSTICO, PTSD, DSM-5, ICD-11, CFA, 诊断, • What is the impact of using a large description of PTSD (i.e. the DSM-5) compared to a small description of PTSD (i.e. the ICD-11 proposal)? In other words, does the size of PTSD really matter? • The present multisite study compares diagnostic rates and model fit of competing DSM-5 and ICD-11 models of PTSD across pain patients, military personnel, and trauma-exposed university students (N = 4213). • The results show that the choice of diagnostic system may influence the estimated PTSD rates both qualitatively and quantitatively. Thus, the size of PTSD does matter. • The proposed ICD-11 three-factor model provided the best fit of the tested ICD-11 models across all samples. • The DSM-5 seven-factor Hybrid model and the DSM-5 six-factor Anhedonia model provided the best fit of the tested DSM-5 models.

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          Background: Researchers and clinicians within the field of trauma have to choose between different diagnostic descriptions of posttraumatic stress disorder (PTSD) in the DSM-5 and the proposed ICD-11. Several studies support different competing models of the PTSD structure according to both diagnostic systems; however, findings show that the choice of diagnostic systems can affect the estimated prevalence rates.

          Objectives: The present study aimed to investigate the potential impact of using a large (i.e. the DSM-5) compared to a small (i.e. the ICD-11) diagnostic description of PTSD. In other words, does the size of PTSD really matter?

          Methods: The aim was investigated by examining differences in diagnostic rates between the two diagnostic systems and independently examining the model fit of the competing DSM-5 and ICD-11 models of PTSD across three trauma samples: university students ( N = 4213), chronic pain patients ( N = 573), and military personnel ( N = 118).

          Results: Diagnostic rates of PTSD were significantly lower according to the proposed ICD-11 criteria in the university sample, but no significant differences were found for chronic pain patients and military personnel. The proposed ICD-11 three-factor model provided the best fit of the tested ICD-11 models across all samples, whereas the DSM-5 seven-factor Hybrid model provided the best fit in the university and pain samples, and the DSM-5 six-factor Anhedonia model provided the best fit in the military sample of the tested DSM-5 models.

          Conclusions: The advantages and disadvantages of using a broad or narrow set of symptoms for PTSD can be debated, however, this study demonstrated that choice of diagnostic system may influence the estimated PTSD rates both qualitatively and quantitatively. In the current described diagnostic criteria only the ICD-11 model can reflect the configuration of symptoms satisfactorily. Thus, size does matter when assessing PTSD.

          Planteamiento: Los investigadores y clínicos del campo del trauma pronto decidirán entre dos descripciones diagnósticas diferentes del trastorno de estrés postraumático (TEPT) en el DSM-5 y la propuesta CIE-11. Varios estudios apoyan diferentes modelos en competencia sobre la estructura del TEPT en función de ambos sistemas de diagnóstico; sin embargo, los resultados demuestran que la elección de los sistemas de diagnóstico puede afectar las tasas de prevalencia estimadas.

          Objetivos: y métodos. El presente estudio tenía como objetivo investigar el impacto potencial de usar una descripción del TEPT amplia (es decir, el DSM-5) en comparación con una pequeña (es decir, la CIE-11). En otras palabras, ¿el tamaño del TEPT importa realmente? El objetivo se investigó mediante el examen de las diferencias en las frecuencias de diagnóstico entre los dos sistemas de diagnóstico y examinando de forma independiente cómo se ajustaban los modelos en competencia para el TEPT del DSM-5 y la CIE-11 en tres muestras de trauma: estudiantes universitarios ( N = 4213), pacientes con dolor crónico ( N = 573) y personal militar ( N = 118).

          Resultados: Las tasas diagnósticas del TEPT fueron significativamente más bajas según los criterios de la propuesta CIE-11 en la muestra universitaria, pero no se encontraron diferencias significativas para los pacientes con dolor crónico y el personal militar. El modelo de tres factores propuesto por la CIE-11 proporcionó el mejor ajuste de los modelos de la CIE-11 que fueron probados en todas las muestras. En cambio, el modelo híbrido de siete factores del DSM-5 proporcionó el mejor ajuste en las muestras universitaria y del dolor, y el modelo de Anhedonia de seis factores del DSM-5 en la muestra militar de los modelos probados del DSM-5.

          Conclusiones: Se pueden debatir las ventajas y desventajas de utilizar un conjunto amplio o reducido de síntomas para el TEPT; sin embargo, este estudio demostró que la elección del sistema de diagnóstico puede influir en las tasas estimadas del TEPT, tanto cualitativa como cuantitativamente. Al mismo tiempo, parece que, dados los criterios diagnósticos descritos actualmente, solo el modelo de la CIE-11 puede reflejar satisfactoriamente la configuración de los síntomas. Por lo tanto, el tamaño importa cuando se evalúa el TEPT.



          目标和方法:本研究旨在探究使用大量(如DSM-5)或者少量(如ICD-11)PTSD症状描述的潜在影响。换言之,PTSD的症状量是否真的重要?我们考察在两个不同诊断系统里的诊断率的差别,并分别在三个创伤样本里考察DSM-5和ICD-11 的PTSD竞争模型的拟合性:大学生样本( N=4213),长期疼痛病人( N=573)和军人样本( N=118)。

          结果:在大学生样本里根据ICD-11提案的PTSD的诊断率显著更低,但是对长期疼痛病人和军人样本没有显著差别。ICD-11提案的三因子模型跨样本拟合最好,但DSM-5七因子混合模型在大学生和疼痛样本中拟合最好,DSM-5 六因子快感缺失模型在军人样本中拟合最好。


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          Most cited references 27

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          Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

          This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record
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            Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model.

            Several revisions to the symptom clusters of posttraumatic stress disorder (PTSD) have been made in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Central to the focus of this study was the revision of PTSD's tripartite structure in DSM-IV into four symptom clusters in DSM-5. Emerging confirmatory factor analytic (CFA) studies have suggested that DSM-5 PTSD symptoms may be best represented by one of two 6-factor models: (1) an Externalizing Behaviors model characterized by a factor which combines the irritability/anger and self-destructive/reckless behavior items; and (2) an Anhedonia model characterized by items of loss of interest, detachment, and restricted affect. The current study conducted CFAs of DSM-5 PTSD symptoms assessed using the PTSD Checklist for DSM-5 (PCL-5) in two independent and diverse trauma-exposed samples of a nationally representative sample of 1484 U.S. veterans and a sample of 497 Midwestern U.S. university undergraduate students. Relative fits of the DSM-5 model, the DSM-5 Dysphoria model, the DSM-5 Dysphoric Arousal model, the two 6-factor models, and a newly proposed 7-factor Hybrid model, which consolidates the two 6-factor models, were evaluated. Results revealed that, in both samples, both 6-factor models provided significantly better fit than the 4-factor DSM-5 model, the DSM-5 Dysphoria model and the DSM-5 Dysphoric Arousal model. Further, the 7-factor Hybrid model, which incorporates key features of both 6-factor models and is comprised of re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptom clusters, provided superior fit to the data in both samples. Results are discussed in light of theoretical and empirical support for the latent structure of DSM-5 PTSD symptoms.
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              The underlying dimensions of DSM-5 posttraumatic stress disorder symptoms in an epidemiological sample of Chinese earthquake survivors.

              The current study investigated the underlying dimensions of DSM-5 PTSD symptoms in an epidemiological sample of Chinese earthquake survivors. The sample consisted of 810 females and 386 males, with a mean age of 47.9 years (SD=10.0, range: 16-73). PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and alternative models were evaluated with confirmatory factor analysis. Results indicated that a six-factor model comprised of intrusion, avoidance, negative affect, anhedonia, dysphoric arousal, and anxious arousal factors emerged as the best fitting model. The current findings add to limited literature on the latent structure of PTSD symptoms described in the recently released DSM-5, and carry implications for further trauma-related research and clinical practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

                Author and article information

                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                13 November 2017
                : 8
                : sup7 , ESTSS Highlights 2017 – Child Maltreatment Across the Lifespan
                [ a ] ThRIVE, Department of Psychology, University of Southern Denmark , Odense M, Denmark
                [ b ] School of Business, National College of Ireland, IFSC , Dublin 1, Ireland
                [ c ] Centre for Global Health, Trinity College Dublin , Dublin 2, Ireland
                [ d ] Research and Knowledge Centre, The Danish Veteran Center , Ringsted, Denmark
                [ e ] Pain Research Group, Pain Center South, Odense University Hospital , Odense C, Denmark
                [ f ] Psychology Research Institute, Ulster University , Coleraine, Northern Ireland
                [ g ] Interdisciplinary Research Unit, Elective Surgery Center, Silkeborg Regional Hospital , Silkeborg, Denmark
                [ h ] Multidisciplinary Pain Center, Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital , Aalborg, Denmark
                Author notes
                CONTACT Maj Hansen mhansen@ 123456health.sdu.dk ThRIVE, Department of Psychology, University of Southern Denmark , Campusvej 55, 5230 Odense M, Denmark
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Tables: 6, References: 43, Pages: 13
                Research Article
                Basic Research Article

                Clinical Psychology & Psychiatry

                ptsd, dsm-5, icd-11, cfa, diagnosis, tept, cie-11, diagnóstico, 诊断


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