Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 10
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Burt, Keith B. Douglas Coatsworth, J. and Masten, Ann S. 2016. Developmental Psychopathology.

    Stein, Dan J. McLaughlin, Katie A. Koenen, Karestan C. Atwoli, Lukoye Friedman, Matthew J. Hill, Eric D. Maercker, Andreas Petukhova, Maria Shahly, Victoria van Ommeren, Mark Alonso, Jordi Borges, Guilherme de Girolamo, Giovanni de Jonge, Peter Demyttenaere, Koen Florescu, Silvia Karam, Elie G. Kawakami, Norito Matschinger, Herbert Okoliyski, Michail Posada-Villa, Jose Scott, Kate M. Viana, Maria Carmen and Kessler, Ronald C. 2014. DSM-5 AND ICD-11 DEFINITIONS OF POSTTRAUMATIC STRESS DISORDER: INVESTIGATING “NARROW” AND “BROAD” APPROACHES. Depression and Anxiety, Vol. 31, Issue. 6, p. 494.

    Weathers, Frank W. Marx, Brian P. Friedman, Matthew J. and Schnurr, Paula P. 2014. Posttraumatic Stress Disorder in DSM-5: New Criteria, New Measures, and Implications for Assessment. Psychological Injury and Law, Vol. 7, Issue. 2, p. 93.

    Rapee, Ronald M. Bőgels, Susan M. van der Sluis, Cathy M. Craske, Michelle G. and Ollendick, Thomas 2012. Annual Research Review: Conceptualising functional impairment in children and adolescents. Journal of Child Psychology and Psychiatry, Vol. 53, Issue. 5, p. 454.

    ter Smitten, Mario H. de Graaf, Ron and Van Loey, Nancy E. 2011. Prevalence and co-morbidity of psychiatric disorders 1–4 years after burn. Burns, Vol. 37, Issue. 5, p. 753.

    Declercq, Frédéric Vanheule, Stijn and Deheegher, John 2010. Alexithymia and posttraumatic stress: subscales and symptom clusters. Journal of Clinical Psychology, Vol. 66, Issue. 10, p. 1076.

    Frueh, B. Christopher Elhai, Jon D. and Acierno, Ron 2010. The Future of Posttraumatic Stress Disorder in the DSM. Psychological Injury and Law, Vol. 3, Issue. 4, p. 260.

    Glaesmer, Heide Gunzelmann, Thomas Braehler, Elmar Forstmeier, Simon and Maercker, Andreas 2010. Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey. International Psychogeriatrics, Vol. 22, Issue. 04, p. 661.

    Richardson, Lisa K. Frueh, B. Christopher and Acierno, Ronald 2010. Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Australian and New Zealand Journal of Psychiatry, Vol. 44, Issue. 1, p. 4.

    Rodin, D. and van Ommeren, M. 2009. Commentary: Explaining enormous variations in rates of disorder in trauma-focused psychiatric epidemiology after major emergencies. International Journal of Epidemiology, Vol. 38, Issue. 4, p. 1045.


The clinical significance criterion in DSM-IV post-traumatic stress disorder

  • DOI:
  • Published online: 01 April 2007

The DSM-IV definition of post-traumatic stress disorder (PTSD) requires that the syndrome cause clinically significant distress or impairment. The impact of the clinical significance criterion on the lifetime prevalence of PTSD among civilian victims of traumatic events has not been evaluated.


Data from two community-based samples were examined, the 1996 Detroit Area Survey of Trauma (n=2181) and the Mid-Atlantic Urban Youth Study (n=1698). The World Health Organization Composite International Diagnostic Interview (WHO CIDI) was used to ascertain DSM-IV PTSD.


The inclusion of the clinical significance criterion in DSM-IV reduces the conditional probability of PTSD given exposure to trauma by approximately 30%. Cases with clinically significant syndrome showed more pervasive and persistent disturbance and an excess in impaired activity days.


The consistency of the findings between the two studies strengthens the evidence on the impact of the clinical significance criterion in the diagnosis of PTSD, and the construct validity of its measurement. There is a need for greater research effort on the definition and measurement of the clinical significance criterion.

Corresponding author
*Address for correspondence: Professor Naomi Breslau, Department of Epidemiology, Michigan State University, College of Human Medicine, B645 West Fee Hall, East Lansing, MI 48824, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G. Andrews , S. Henderson & W. Hall (2001). Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. British Journal of Psychiatry 178, 145153.

N. Breslau & R. C. Kessler (2001). The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation. Biological Psychiatry 50, 699704.

N. Breslau , R. C. Kessler , H. D. Chilcoat , L. R. Schultz , G. C. Davis & P. Andreski (1998 a). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626632.

N. Breslau , R. C. Kessler & E. L. Peterson (1998 b). PTSD assessment with a structured interview: reliability and concordance with a standardized clinical interview. International Journal of Methods in Psychiatric Research 7, 121127.

N. Breslau , H. C. Wilcox , C. L. Storr , V. C. Lucia & J. C. Anthony (2004). Trauma exposure and posttraumatic stress disorder: a study of youths in urban America. Journal of Urban Health 81, 530544.

B. P. Dohrenwend , J. B. Turner , N. A. Turse , B. G. Adams , K. C. Koenen & R. Marshall (2006). The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science 313, 979982.

S. G. Kellam & J. C. Anthony (1998). Targeting early antecedents to prevent tobacco smoking: findings from an epidemiologically based randomized field trial. American Journal of Public Health 88, 14901495.

S. G. Kellam , L. Werthamer-Larsson , L. J. Dolan , C. H. Brown , L. S. Mayer , G. W. Rebok , J. C. Anthony , J. Laudolff & G. Edelsohn (1991). Developmental epidemiologically based preventive trials: baseline modeling of early target behaviors and depressive symptoms. American Journal of Community Psychology 19, 563584.

R. C. Kessler & R. G. Frank (1997). The impact of psychiatric disorders on work loss days. Psychological Medicine 27, 861873.

R. J. McNally (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology 54, 229252.

W. E. Narrow , D. S. Rae , L. N. Robins & D. A. Regier (2002). Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates. Archives of General Psychiatry 59, 115123.

T. Slade & G. Andrews (2002). Empirical impact of DSM-IV diagnostic criterion for clinical significance. Journal of Nervous and Mental Disorders 190, 334337.

P. Tyrer (2005). From the Editor's desk. British Journal of Psychiatry 186, 552.

J. C. Wakefield & R. L. Spitzer (2002). Lowered estimates – but of what? Archives of General Psychiatry 59, 129130.

L. Werthamer-Larsson , S. Kellam & L. Wheeler (1991). Effect of first-grade classroom environment on shy behavior, aggressive behavior, and concentration problems. American Journal of Community Psychology 19, 585602.

S. Wessely (2005). Risk, psychiatry and the military. British Journal of Psychiatry 186, 459466.

M. Zimmerman , I. Chelminski & D. Young (2004). On the threshold of disorder: a study of the impact of the DSM-IV clinical significance criterion on diagnosing depressive and anxiety disorders in clinical practice. Journal of Clinical Psychiatry 65, 14001405.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *