Clinicians' understanding of International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnostic criteria: F62.0 enduring personality change after catastrophic experience

Abstract 

International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) has included a diagnostic category of “enduring personality change after catastrophic experience” (EPCACE). Preliminary investigation suggests that there is considerable endorsement in principle for this new category among experts in the field of intentional human trauma, yet many aspects of the diagnosis remain contentious. Criticisms leveled at EPCACE raised issues that question the reliability, validity, and clinical utility of this diagnostic category. In ICD-10, there are 2 sets of documents describing EPCACE criteria. These are Diagnostic Criteria for Research (DCR) and Clinical Descriptions and Diagnostic Guidelines (CDDG). This study examines how clinicians described the symptoms that conform to or exceed the criteria of EPCACE that they observed in their clients. No other published research examining the descriptive validity of this category has emerged.

A qualitative approach from social phenomenology and applied policy research perspectives was used to gather the views and experiences of clinicians. Twenty-four clinicians working in the area of torture and refugee trauma, war trauma, and sexual assault trauma were interviewed in depth.

Using the CDDG, clinicians were able to typify the characteristic symptom criteria of EPCACE. Hostile or mistrustful attitude was identified as a prominent symptom. Somatization, self-injurious behaviors, sexual dysfunction, and enduring guilt are suggested additional features that are not encompassed by current EPCACE criteria.

This study contributes to the descriptive validity of EPCACE. It demonstrates the utility of a qualitative approach to descriptive validation of diagnostic criteria. Participation of clinicians as members of working parties in the development and review of diagnostic criteria is recommended. The symptom descriptors generated from this study could be used to enhance CDDG.