Chp 3/5: PTSD & Clinical Assessments

What is the purpose of clinical assessment?

To understand psychological, biological, and social factors influencing behavior, inform diagnosis, guide treatment plans, and predict outcomes.

What are the key characteristics of assessment tools?

Standardization, reliability (test-retest and interrater), and validity (face, predictive, and concurrent).

What does standardization in assessment tools refer to?

The consistent administration and scoring of tests in the same conditions.

What is reliability in the context of clinical assessments?

The consistency of measurement or score across different administrations.

Test-Retest (Reliability)

Same patients score remain stable across time

Interrater (Reliability)

the consistency of scores between different observers.

What does validity measure in assessment tools?

The accuracy of the tool in measuring what it is intended to measure.

What are the three types of validity?

Face validity, predictive validity, and concurrent validity.

Face Validity

Clear indication of measuring disorder score

Predictive Validity

Test score predicting onset of different conditions

Concurrent Validity

One test having High correlation with another condition

What are projective tests designed to uncover?

Unconscious conflicts.

Personality Inventories

Standardized measures of personality (test scores)

Response Inventories

Assess specific areas of functions (track changes in symptoms)

Psychophysiological tests

Measure physical responses

Neurological test

Assess brain structure and functions (MRI, ADHD testing)

Naturalistic Observation

Watching behavior in real-world setting

Analog observation

Structured, simulated environments (video-tapping etc)

Self-Monitoring

Patient tracks own thoughts, emotions, or behaviors

Intelligence tests

Evaluate intellectual abilities (verbal, processing, learning)

Historical Approaches

Emil Kraepelin categories - precursor to modern diagnostic manuals

What are the strengths of the DSM-5 classification system?

Improves reliability and communication among professionals.

What are some limitations of the DSM-5?

High comorbidity, where many patients meet criteria for multiple disorders.

What is a key component of CBT?

A structured approach that includes exposure therapy and cognitive restructuring.

Dissociative disorders

Involve disruptions in memory, identity, or perception, often linked to trauma.

Posttraumatic Stress Disorder (PTSD)

A disorder characterized by exposure to actual or threatened death, serious injury, or sexual violence.

DSM-5-TR Criteria for PTSD

First hand/ witness, learning of event & experiencing repeated or extreme exposure to aversive details of event. Intrusion, avoidance, negative alteration in mood/cognition, alteration in arousal >1 month

Intrusion symptoms

Involuntary, distressing memories, dreams, dissociative reactions (flashbacks), and marked physiological reactions to reminders.

Persistent Avoidance symptoms

avoidance of stimuli associated with the trauma (memories, thoughts, feelings, etc)

Negative alterations in cognition and mood

Includes inability to remember important aspects of the trauma, persistent negative beliefs about self/world/others, diminished interest in activities, feelings of detachment, and inability to experience positive emotions.

Marked alterations in arousal and reactivity

Includes irritable behavior, angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance.

Acute Stress Disorder (ASD)

A disorder characterized by exposure to actual or threatened death, serious injury, or sexual violation, less duration compared to PSTD

DSM-5-TR Criteria for ASD

Presence of 9+ symptoms from; intrusion, negative mood, dissociation, avoidance, and arousal. Symptoms lasting from 3 days - 1 month after trauma exposure. CORE symptoms is acute dissociation

Adjustment Disorder

A disorder characterized by emotional or behavioral symptoms in response to an identifiable stressor(s) within 3 months of stressor onset. Resolves after 6 months

Clinically significant symptoms in Adjustment Disorder

Marked distress out of proportion to severity/intensity of stressor or significant impairment in social, occupational, or other areas of functioning.

Dissociative Amnesia

Inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

Dissociative Fugue

Sudden, unexpected travel away from home/work with inability to recall some or all past. Confusion about personal identity or assumption of a new identity. Duration: hours to months.

Dissociative Identity Disorder (DID)

Disruption of identity characterized by 2+ distinct personality states (alters) and recurrent gaps in recall of everyday events, important personal information, or traumatic events.

Depersonalization/Derealization Disorder

Persistent/recurrent experiences of depersonalization (detachment from self) and/or derealization (world feels unreal) with reality testing intact.

PTSD Treatment

Trauma-focused CBT, EMDR, SSRI, support group

ASD Treatment

Early CBT, psychoeducation, grounding techniques, short-term supportive therapy

DID Clinical Features of Alters

Distinct names, ages, genders, behaviors; awareness varies: mutually amnesic, mutually cognizant, or one-way awareness.

DID Physiological Differences

Physiological differences may occur (allergies, handedness).