Diagnosis and differential diagnosis Diagnostic criteria in ICD10 and DSMIV

Table,! compares the diagnostic criteria of ICD-10 and DSM-IV. (19 ICD-10 research diagnostic criteria, (1.9 as well as diagnostic guidelines,(5) are included. The diagnostic systems agree on the core symptoms of PTSD—re-experiencing, avoidance, emotional numbing, and hyperarousal—but differ in the weight assigned to them.

Table 1 Diagnostic criteria for PTSD in ICD-10 and DSM-IV

• DSM-IV puts a stronger emphasis on the avoidance/numbing cluster of symptoms by requiring a minimum of three of these symptoms. Although emotional numbing is listed prominently in the ICD-10 diagnostic guidelines, it was not included in the ICD-10 research diagnostic criteria. As a consequence, patients that meet ICD-10 criteria may not fulfil the criteria for a DSM-IV PTSD diagnosis if they have too few of the numbing symptoms. They would be diagnosed as having an adjustment disorder according to DSM-IV.

• The ICD-10 research diagnostic criteria require the patient to either suffer from psychogenic amnesia or hyperarousal symptoms. Thus, in contrast to DSM-IV, a patient could be diagnosed as having PTSD in the absence of hyperarousal symptoms if amnesia is present.

• DSM-IV states two additional criteria that are not included in ICD-10. First, it requires a minimum symptom duration of 1 month because acute stress disorder would be diagnosed before 4 weeks have elapsed. Second, it requires that the symptoms cause significant distress or impaired functioning.

• Thus, although the diagnostic systems largely agree on the type of symptoms that characterize PTSD, DSM-IV criteria are stricter. A recent large-scale study (19> found a prevalence of ICD-10 PTSD of 6.9 per cent, and a prevalence of DSM-IV PTSD of 3 per cent. The concordance between the diagnostic systems was only 35 per cent. The concordance could have been increased to 56 per cent if ICD-10 included a criterion of emotional numbing and if the DSM-IV disability criterion was dropped.

Was this article helpful?

0 0
Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

Get My Free Ebook

Post a comment