Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5

Objective: There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non–Criterion A stressors. Criterion A events might have greater predictive validity for International Classification of Diseases (ICD)-11 PTSD, which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an expanded trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed whether 5 psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as standard Criterion A events. Method: A nationally representative sample from Ireland (N = 1,020) completed self-report measures. Results: Most participants were trauma-exposed based on Criterion A (82%) and the expanded (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD, 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The 5 psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect). Conclusions: Certain non–Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Clinical Impact Statement: A diagnosis of posttraumatic stress disorder (PTSD) requires that a person has experienced a traumatic life event; however, difficulties in defining what is, and what is not, a trauma has threatened the construct validity of PTSD. The newly released 11th version of the International Classification of Diseases (ICD-11: World Health Organization, 2018) provides clinicians with guidance, rather than a formal definition, for what constitutes a traumatic event. In this study, we show that psychologically threatening events such as emotional abuse, neglect, bullying, and stalking that would not normally be considered traumatic were uniquely associated with meeting the diagnostic requirements for PTSD and Complex PTSD. The ICD-11 approach of considering an event as traumatic if it is extremely threatening or horrific is helpful because it provides a context to understand trauma-related symptoms while allowing clinicians flexibility in determining what is a potentially traumatic experience. (PsycInfo Database Record (c) 2021 APA, all rights reserved)