Unintended Consequences of Changing the Definition of Posttraumatic Stress Disorder in DSM-5: Critique and Call for Action

This Special Communication argues against changing the definition of posttraumatic stress disorder in DSM-5.Are changes to the definition of posttraumatic stress disorder in DSM-5 a step forward? -No. The purpose of revising a psychiatric definition is to enhance diagnostic accuracy, clinical utility, and communication. The DSM-5 definition of PTSD provides no improvement in these areas. This has profound implications for patients with PTSD per DSM-IV for whom well-established treatments exist and for patients with impairment meeting DSM-5 criteria for whom treatments may not generalize. Psychiatric case definitions are not implemented in health care settings as hypotheses, and there are screening, insurance, disability, and forensic ramifications. Essentially, what the new definition appears to have accomplished is a disruption of the long chain of links, established through epidemiological, neurobiological, and treatment studies, providing the foundation of current practice for patients with PTSD. Expedited reconsideration or revision is required. Meanwhile, inthe interestsof patient care, continued use of the DSM-IV formulationandcorrespondinginstruments is necessary.Research proposals enrollingpatients withPTSDshouldbeclosely scrutinized if their design does not encompass DSM-IV criteria. Patients who meet DSM-IV criteria should continue to be diagnosed as having PTSD and not denied trauma-focused treatment or entitlements based on the DSM-5 definition. We cannot assume that established neurobiological or treatment paradigms apply to patients identified only under DSM-5 (or ICD-11).

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Reference: 
Charles W. Hoge, Rachel Yehuda, Carl A. Castro, Alexander C. McFarlane, Eric Vermetten, Rakesh Jetly, Karestan C. Koenen, Neil Greenberg, Arieh Y. Shalev, Sheila A. M. Rauch, Charles R. Marmar, & Barbara O. Rothbaum | 2016
In: JAMA Psychiatry, ISSN 2168-622X | 73 | 7 | juli | 750-752
http://archpsyc.jamanetwork.com/article.aspx
Affiliation author(s): 
ARQ National Psychotrauma Centre