The DSM-5 Got PTSD Right: Comment on Friedman (2013)

Friedman in his article in this issue describes the posttraumatic stress disorder (PTSD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and provides considerable information about the process that resulted in the revisions, as well as how PTSD in the DSM-5 differs from proposals for PTSD in the International Classification of Mental Disorders and Related Health Problems (ICD-11). In this commentary, I argue that (a) the placement of PTSD in the DSM-5 category of Trauma and Stressor-Related Disorders is a major advance because it draws attention to the role of "nurture" when there is an overemphasis on "nature" by some; (b) the broader construct of PTSD in DSM-5 is justified because it includes clinically important problems and can be reliably diagnosed; and (c) the web surveys contributed substantially to the provision of data needed to support proposed changes. Concerns are raised about the proposed ICD-11 approach, and the case is presented that substantial evidence should be required before these proposed changes are made because they differ substantially from a DSM-5 PTSD diagnosis that has demonstrated reliability and validity.