MedicalResearch.com Interview with:
Charles W. Hoge, M.D.
Walter Reed Army Institute of Research
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Hoge: Psychiatric definitions are revised periodically based on emerging science, with the intention of enhancing diagnostic accuracy, clinical utility, and communication. The latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders was published in 2013 (DSM-5). However, there were an unusually large number of changes to the PTSD definition compared with other common conditions affecting adults, raising concerns with how well these changes truly reflected emerging evidence. Since DSM-5 was published, evidence has accumulated that indicates that the revision did not improve the definition, and more importantly excludes nearly a third of individuals who would have met the previous DSM-IV definition.
This article in JAMA Psychiatry provides a thorough critique of the problems with the new definition. It was written by 12 of the leading PTSD experts in the world, including strong representation from experts with experience treating veterans and service members. An accompanying editorial by U.S. Veterans Affairs researchers criticizes our findings, but lacks the scientific rigor of our analysis; for example, every reference they cite we also cite in direct support of our conclusions.
MedicalResearch.com: What should readers take away from your report?
Dr. Hoge: The most important take away from our paper is that expedited reconsideration of the new PTSD definition is required, and continued use of the original DSM-IV definition is necessary to ensure patients receive the care they need. Patients who meet DSM-IV criteria should continue to be diagnosed with PTSD, and not denied trauma-focused treatment based solely on DSM-5. Since all of our treatments for PTSD have been validated according to the DSM-IV definition, we do not know if well-established treatments will apply equally to patients identified only under DSM-5, and this will require close evaluation. In addition, research proposals enrolling PTSD patients should be closely scrutinized if their design does not encompass DSM-IV criteria.
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