The Role of Criterion A2 in the DSM-IV Diagnosis of Posttraumatic Stress Disorder

Author(s):Show less -

Karam, Elie George ; Andrews, Gavin ^[1] ; Bromet, Evelyn ^[2] ; Petukhova, Maria ^[3] ; Ruscio, Ayelet Meron ^[4] ; Salamoun, Mariana ; Sampson, Nancy ^[3] ; Stein, Dan J. ^[5] ; Alonso, Jordi ^[6] ; Andrade, Laura Helena ^{[7, 8]} ; Angermeyer, Matthias ^[9] ; Demyttenaere, Koen ^[10] ; de Girolamo, Giovanni ^[11] ; de Graaf, Ron ^[12] ; Florescu, Silvia ^[13] ; Gureje, Oye ^[14] ; Kaminer, Debra ^[15] ; Kotov, Roman ^[16] ; Lee, Sing ^[17] ; Lepine, Jean-Pierre ^[18] ; Medina-Mora, Maria Elena ^[19] ; Browne, Mark A. Oakley ^[20] ; Posada-Villa, Jose ^[21] ; Sagar, Rajesh ^[22] ; Shalev, Arieh Y. ^[23] ; Takeshima, Tadashi ^[24] ; Tomov, Toma ^[25] ; Kessler, Ronald C. ^[3]

Affiliation:Show less -

^[1] Univ New S Wales, Dept Psychiat, Sydney, NSW - Australia

^[2] SUNY Stony Brook, Stony Brook, NY 11794 - USA

^[3] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 - USA

^[4] Univ Penn, Dept Psychol, Philadelphia, PA 19104 - USA

^[5] Groote Schuur Hosp, Dept Psychiat, ZA-7925 Cape Town - South Africa

^[6] Hosp del Mar, Ctr Invest Biomed Red Epidemiol & Salud Publ, Inst Municipal Invest Med, Serv Res Unit, Barcelona - Spain

^[7] Univ Sao Paulo, Sch Med, Inst Psychiat, Sao Paulo - Brazil

^[8] Univ Sao Paulo, Sch Med, Sect Psychiat Epidemiol, LIM Dept 23, Sao Paulo - Brazil

^[9] Ctr Publ Mental Hlth, Gosing Am Wagram - Austria

^[10] Univ Hosp Gasthuisberg, Dept Psychiat, B-3000 Leuven - Belgium

^[11] Ctr S Giovanni Dio Fatebenefratelli, Ist Ricovero & Cura Carattere Sci, Brescia - Italy

^[12] Netherlands Inst Mental Hlth & Addict, Psychiat Epidemiol Unit, Monitoring & Epidemiol Dept, Utrecht - Netherlands

^[13] Natl Sch Publ Hlth & Hlth Serv Management, Dept Psychiat, Publ Hlth Res & Evidence Based Med Dept, Bucharest - Romania

^[14] Univ Coll Ibadan Hosp, Ibadan - Nigeria

^[15] Univ Stellenbosch, MRC, Res Unit Anxiety Disorders, Cape Town - South Africa

^[16] SUNY Stony Brook, Dept Psychiat, Stony Brook, NY 11794 - USA

^[17] Chinese Univ Hong Kong, Dept Psychiat, Hong Kong, Hong Kong - Peoples R China

^[18] Univ Paris Diderot, Hop Lariboisiere Fernand Widal, AP HP, CNRS, INSERM, U705, UMR 7157, Paris - France

^[19] Natl Inst Psychiat Ramon Fuente, Mexico City, DF - Mexico

^[20] Univ Tasmania, Discipline Psychiat, Hobart, Tas 7001 - Australia

^[21] Colegio Mayor Cundinamarca Univ, Bogota - Colombia

^[22] All India Inst Med Sci, Dept Psychiat, New Delhi - India

^[23] Hadassah Univ Hosp, Dept Psychiat, IL-91120 Jerusalem - Israel

^[24] Natl Ctr Neurol & Psychiat, Natl Inst Mental Hlth, Tokyo - Japan

^[25] New Bulgarian Univ, Dept Psychiat, Sofia - Bulgaria

• Document type: Journal article
• Source: BIOLOGICAL PSYCHIATRY; v. 68, n. 5, p. 465-473, SEP 1 2010.
• Web of Science Citations: 51

Abstract

Background: Controversy exists about the utility of DSM-IV posttraumatic stress disorder (PTSD) criterion A2 (A2): that exposure to a potentially traumatic experience (PTE; PTSD criterion A1) is accompanied by intense fear, helplessness, or horror. Methods: Lifetime DSM-IV PTSD was assessed with the Composite International Diagnostic Interview in community surveys of 52,826 respondents across 21 countries in the World Mental Health Surveys. Results: Of 28,490 representative PTEs reported by respondents, 37.6% met criterion A2, a proportion higher than the proportions meeting other criteria (B-F; 5.4%-9.6%). Conditional prevalence of meeting all other criteria for a diagnosis of PTSD given a PTE was significantly higher in the presence (9.7%) than absence (.1%) of A2. However, as only 1.4% of respondents who met all other criteria failed A2, the estimated prevalence of PTSD increased only slightly (from 3.64% to 3.69%) when A2 was not required for diagnosis. Posttraumatic stress disorder with or without criterion A2 did not differ in persistence or predicted consequences (subsequent suicidal ideation or secondary disorders) depending on presence-absence of A2. Furthermore, as A2 was by far the most commonly reported symptom of PTSD, initial assessment of A2 would be much less efficient than screening other criteria in quickly ruling out a large proportion of noncases. Conclusions: Removal of A2 from the DSM-IV criterion set would reduce the complexity of diagnosing PTSD, while not substantially increasing the number of people who qualify for diagnosis. Criterion A2 should consequently be reconceptualized as a risk factor for PTSD rather than as a diagnostic requirement. (AU)

• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants