Comparison of the ICD-10 PTSD Diagnosis With the DSM-IV Criteria

The DSM-IV-TR is the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, with text revision added in 2000. The manual, published by the American Psychiatric Association, presents the criteria most widely used in the United States to classify mental disorders.

The International Classification of Diseases (ICD) is the classification used since 1994 by the World Health Organization (WHO). It has become the international standard diagnostic classification for most general epidemiological purposes. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines (2) provides international guidelines for the diagnosis of PTSD.

The DSM-IV-TR and ICD-10 criteria for diagnosis of PTSD are similar but there are also some differences.

Both sets of diagnostic criteria for PTSD include a history of exposure to a traumatic event and symptoms from each of three symptom clusters. The symptom clusters include intrusive recollections, avoidant symptoms, and hyper-arousal symptoms. Both also include a criterion concerning duration of symptoms. The ICD-10 does not specify a functioning criterion, as does DSM-IV-TR (Criterion F).

The ICD-10 criteria are outlined below, with differences from DSM-IV-TR noted.

Criterion A: Stressor

Exposure to a stressor. Unlike DSM there is no subjective stressor criterion (A2).

Criterion B: Re-experiencing

Persistent remembering of the stressor in one (as is true in the DSM-IV-TR) of:

• Intrusive flashbacks
• Vivid memories or recurring dreams
• Experiencing distress when reminded of the stressor

Criterion C: Avoidance

Requires only one symptom of actual or preferred avoidance. DSM-IV-TR requires three symptoms from this cluster, and includes both numbing and avoidance symptoms whereas the ICD-10 does not.

Criterion D: Hyper-arousal

Either D1, or two of D2. DSM-IV-TR requires two symptoms from this entire hyper-arousal cluster).

D1: Inability to recall

D2: Two or more of:

• Sleep problems
• Irritability
• Concentration problems
• Hypervigilance
• Exaggerated startle response

Criterion E

Onset of symptoms within 6 months of the stressor. This differs from DSM-IV-TR which specifies symptom duration of greater than one month.

References

1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.
2. World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva, Switzerland: Author.