The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity

Blair E. Wisco, Mark W. Miller, Erika J. Wolf, Dean Kilpatrick, Heidi S. Resnick, Christal L. Badour, Brian P. Marx, Terence M. Keane, Raymond C. Rosen, Matthew J. Friedman

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


The World Health Organization's posttraumatic stress disorder (PTSD) work group has published a proposal for the forthcoming edition of the International Classification of Diseases (ICD-11) that would yield a very different diagnosis relative to DSM-5. This study examined the impact of the proposed ICD-11 changes on PTSD prevalence relative to the ICD-10 and DSM-5 definitions and also evaluated the extent to which these changes would accomplish the stated aim of reducing the comorbidity associated with PTSD. Diagnostic prevalence estimates were compared using a U.S. national community sample and two U.S. Department of Veterans Affairs clinical samples. The ICD-11 definition yielded prevalence estimates 10-30% lower than DSM-5 and 25% and 50% lower than ICD-10 with no reduction in the prevalence of common comorbidities. Findings suggest that by constraining the diagnosis to a narrower set of symptoms, the proposed ICD-11 criteria set would substantially reduce the number of individuals with the disorder. These findings raise doubt about the extent to which the ICD-11 proposal would achieve the aim of reducing comorbidity associated with PTSD and highlight the public health and policy implications of such a redefinition.

Original languageEnglish
Pages (from-to)226-233
Number of pages8
JournalPsychiatry Research
StatePublished - Jun 30 2016

Bibliographical note

Funding Information:
Data collection was funded by an American Psychiatric Association DSM grant to Dean Kilpatrick and the U.S. Department of Veterans Affairs . Manuscript preparation was supported by a VA Merit Review grant ( 5I01CX000431 ) awarded to Mark Miller, a VA Clinical Sciences Research and Development Program Career Development Award to Erika Wolf, funding from the National Institute of Mental Health ( 1R01MH095737-01A1 ), U.S. Department of Defense ( W81XWH-12-2-0117-PTSD-IIRA-INT ), Defense Advanced Research Programs Agency ( N66001-11-C-4006 ) and U.S. Department of Veterans Affairs (Cooperative Studies Program # 591 ) awarded to Dr. Marx, and funding from the U.S. Department of Defense ( W81XWH-10-2-0181 ) awarded to Drs. Marx and Keane. The authors have no conflicts of interest to report. Drs. Friedman and Kilpatrick served on the Trauma/Stressor-Related and Dissociative Disorders Sub-Work Group of the Anxiety Disorder Work Group of DSM-5 . Contents are solely the responsibility of the authors and views expressed do not represent those of the APA, the U.S. Department of Veterans Affairs, the U.S. Government, or other agencies supporting this research.

Publisher Copyright:
© 2016.


  • DSM-5
  • Diagnosis
  • Diagnostic criteria
  • ICD-11
  • PTSD
  • Trauma

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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