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.

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