Comparison of posttraumatic stress disorder (PTSD) in DSM-5 and ICD-11 in children and adolescents: rates of probable PTSD, diagnostic agreement, and comorbidity

Eur J Psychotraumatol. 2025 Dec;16(1):2568339. doi: 10.1080/20008066.2025.2568339. Epub 2025 Oct 28.

ABSTRACT

Background and objective: The revisions of the DSM-5 and ICD-11 introduced several changes that altered the conceptualization of posttraumatic stress disorder (PTSD), potentially affecting diagnosis of children and adolescents. This study investigates the differences in rates of PTSD, diagnostic agreement, and comorbidity in children and adolescents when using DSM-5 or ICD-11.Method: The study is based on secondary analysis of data. Sample 1 and 2 consist of children and adolescents referred to mental health clinics (CAMHS) across Norway and sample 3 includes children referred to community services for trauma treatment. The total sample consisted of 290 children and adolescents (ages 7-18). Cohen’s kappa, McNemar tests and bootstrapped estimates with 95% CI were used to investigate our research questions.Results: The rate of _DSM-5PTSD (55.9%) was significantly higher than _ICD-11PTSD (33.2%), which seems to be particularly related to the re-experiencing criterion. There was a weak agreement of 74.5% between the two diagnoses manuals (kappa = .51). Using DSM-5 showed larger overlap between depression and PTSD (24.5% vs. 12.3%), as well as attention difficulties and PTSD (21.8% vs. 12.1%) as compared to ICD-11. However, our results also suggest that comorbidity rates for those with PTSD may be higher when using ICD-11 criteria compared to DSM-5 criteria (61.9% vs 53.1.% for depression).Conclusions: The results indicate that choice of diagnostic manual can influence whether children meet diagnostic criteria. Using ICD-11 criteria may help identify a subgroup of children and adolescents with more severe PTSD symptom profiles. Whereas using ICD-11 criteria is associated with high specificity of the diagnosis, it seems to also increase the comorbidity among those diagnosed. In contrast, utilizing DSM-5 criteria may identify children and adolescents with less distinct symptom presentations. Choice of diagnostic manual may influence access to evidence-based treatment.

PMID:41147898 | DOI:10.1080/20008066.2025.2568339