Research report Post-traumatic stress disorder in DSM-5: Estimates of prevalence and criteria comparison versus DSM-IV-TR in a non-clinical sample of earthquake survivors C. Carmassi a,n , H.S. Akiskal b , S.S. Yong b , P. Stratta c , E. Calderani a , E. Massimetti a , K.K. Akiskal b , A. Rossi c , L. Dell'Osso a a Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy b International Mood Center, University of California at San Diego, La Jolla, CA, USA c Section of Psychiatry, Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy article info Article history: Received 26 June 2013 Received in revised form 29 July 2013 Accepted 31 July 2013 Available online 26 August 2013 Keywords: PTSD Earthquake DSM-5 Criteria Post-traumatic stress symptoms abstract Background: The latest edition of DSM (DSM-5) introduced important revisions to PTSD symptomato- logical criteria, such as a four-factor model and the inclusion of new symptoms. To date, only a few studies have investigated the impact that the proposed DSM-5 criteria will have on prevalence rates of PTSD. Methods: An overall sample of 512 adolescents who survived the L'Aquila 2009 earthquake and were previously investigated for the presence of full and partial PTSD, using DSM-IV-TR criteria, were reassessed according to DSM-5 criteria. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR). Results: A DSM-5 PTSD diagnosis emerged in 39.8% of subjects, with a significant difference between the two sexes (p o0.001), and an overall 87.1% consistency with DSM-IV-TR. Most of the inconsistent diagnoses that fulfilled DSM-IV-TR criteria but not DSM-5 criteria can be attributed to the subjects not fulfilling the new criterion C (active avoidance). Each DSM-5 symptom was more highly correlated with its corresponding symptom cluster than with other symptom clusters, but two of the new symptoms showed moderate to weak item-cluster correlations. Among DSM-5 PTSD cases: 7 (3.4%) endorsed symptom D3; 151 (74%) D4; 28 (13.7%) both D3 and D4; 75 (36.8%) E2. Limitations: The use of a self-report instrument; no information on comorbidity; homogeneity of study sample; lack of assessment on functional impairment; the rates of DSM-IV-TR qualified PTSD in the sample was only 37.5%. Conclusions: This study provides an inside look at the empirical performance of the DSM-5 PTSD criteria in a population exposed to a natural disaster, which suggests the need for replication in larger epidemiological samples. & 2013 Published by Elsevier B.V. 1. Introduction The diagnostic criteria for post-traumatic stress disorder (PTSD) have undergone several modifications since the disorder's first appearance in the third edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Although questions remain over the distinctive- ness of the disorder as a unique clinical syndrome (Spitzer et al., 2007), new revisions of the PTSD criteria have been proposed in the latest edition of DSM (DSM-5) (APA, 2013; Forbes et al., 2011; Friedman et al., 2011). The first relevant change in the DSM-5 made by the work group for Anxiety, Obsessive–Compulsive Spectrum, Post-traumatic and Dissociative Disorders is the exclu- sion of PTSD from the section of anxiety disorders and its inclusion in the new section “Trauma- and Stressor-Related Disorders”, that accounts for specific syndromes related to the exposure to trauma or stressful events. Furthermore, changes have been added to the diagnostic criteria both to the stressor criterion and to the symptomatological criteria. The revised stressor criterion (DSM- IV-TR PTSD criterion A1 and A2) restricts the range of traumatic events encoded in criterion A1 and deletes criterion A2 (subjective reactions of intense fear, helplessness or horror to the stressor event). The revised symptomatological criteria include the addi- tion of three new symptoms as well as the replacement of the three-factor model of PTSD (i.e., Cluster B re-experiencing, Cluster C avoidance/numbing, and Cluster D hyper-arousal) with the new four-factor model (consisting of: Cluster B intrusion symptoms, Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders 0165-0327/$ - see front matter & 2013 Published by Elsevier B.V. http://dx.doi.org/10.1016/j.jad.2013.07.020 n Correspondence to: Department of Clinical and Experimental Medicine, University of Pisa Via Roma 67, 56100 Pisa, Italy. Tel.: þ39 050 2219766; fax: þ39 050 2219787. E-mail address: ccarmassi@gmail.com (C. Carmassi). Journal of Affective Disorders 151 (2013) 843–848