Diagnostic and statistical manual of mental disorders, fifth edition, and the impact of events scale-revised.

We read with great interest the article by Bienvenu et al 1 in a recent issue of CHEST (July 2013) and would like to compliment them on the development and validation of the Impact of Events Scale-Revised (IES-R) for patients with posttraumatic stress disorder (PTSD) after acute lung injury. Psychiatric nosology and diagnostic classifi cation systems are always dynamic and in a state of fl ux. The authors developed the screening questionnaire and validated it against the Clinician-Administered PTSD Scale (CAPS), which is based on Diagnostic and Statistical Manual of Mental Disorders (DSM), fourth edition, diagnostic criteria. However, the recently introduced fi fth edition (DSM-5) has revised the conceptualization as well as the diagnostic criteria for PTSD, which has defi nite implications for the screening instrument proposed in the study. PTSD was moved from the class of anxiety disorders into a new class of trauma and stressor-related disorders. The cluster of symptoms in the fourth edition has been expanded in DSM-5 to include intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. DSM-5 now requires at least one avoidance symptom for a PTSD diagnosis. Three new symptoms were added: two in criteria D (negative alterations in cognitions and mood) to include persistent, distorted blame of self or others and persistent negative emotional state and one in criteria E (alterations in arousal and reactivity) to include reckless or destructive behavior. 2 Criterion A2 (requiring fear, helplessness, or horror happening right after the trauma) was removed in DSM-5 because research suggested that this criterion does not improve diagnostic accuracy. 3 A clinical subtype with dissociative symptoms was added for those who meet the criteria for PTSD and experience additional depersonalization and derealization symptoms. CAPS, the psychometric instrument against which the IES-R was validated, is currently being revised to ensure its compatibility with DSM-5 diagnostic criteria for PTSD. These changes lead to the inference that the IES-R would require substantial revision and validation against the revised CAPS to ensure its clinical utility in the future.