PTSD Assessment

Assessment of Trauma and Reactions to Trauma

PSYC 385 Psychological Test - Fall 2025

Defining “T”rauma

  • Definition: Trauma refers to experiences or witnessing of events in which there is actual or threatened death, serious injury, or violence as defined by the American Psychiatric Association.

  • Debate: The definition of trauma is highly debated and frequently used colloquially, leading to potential misunderstandings.

Additional Factors to Consider

  • Temporal Aspect: Consider when the trauma occurred (i.e., childhood vs. adulthood).

  • Frequency of Exposure: The number of times an individual has encountered traumatic events.

  • Type of Trauma: Different traumas can have varying impacts and reactions.

Common Reactions to Trauma

  • General Overview: Various psychological responses can occur following trauma.

What is PTSD?

  • Full Definition: PTSD (Post-Traumatic Stress Disorder) develops after exposure to a traumatic event.

  • Concept of Failed Recovery: PTSD has been referred to as a failed recovery due to persistent symptoms such as a constant "fight-or-flight" response and lack of extinction of fear.

  • Differences in Coping: Individual coping strategies affect how one recovers after trauma and may impede natural recovery processes.

  • Age Range: PTSD can emerge at any age.

  • Symptom Onset: Symptoms typically arise within the first few months after the traumatic event, although there can be “Delayed Expression.”

  • Standard Trajectory: Most individuals experience Acute Stress Disorder and recover within three months; when symptoms persist, they may develop into PTSD.

DSM-5-TR (APA, 2022)

  • Onset of PTSD: Often begins as Acute Stress Disorder.

Prevalence of PTSD

  • General Statistics: Approximately 7-8% of the US population will experience PTSD at some point in their lives.

  • Military Population: Higher prevalence rates are noted in military veterans, with 11–30% affected (varies by war era).

  • Gender Disparities: Women are diagnosed with PTSD more frequently than men; approximately 10% of women vs. 4% of men.

  • Source: National Center for PTSD (https://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp)

“Stressor Criterion”

Criterion A

  • Exposure Types: Exposure to actual or threatened death, serious injury, or sexual violence can occur in the following ways:

    1. Directly experiencing the trauma.

    2. Witnessing it in person.

    3. Learning about the event happening to a close family member or friend.

    4. Repeated or extreme exposure (e.g., first responders).

  • Exclusions: Exposure through electronic media, TV, or pictures generally does not meet Criterion A.

PTSD Symptoms

Criterion B: Re-experiencing

  • At least one of the five symptoms must be present:

    • Intrusive, distressing thoughts or memories.

    • Flashbacks.

    • Emotional or physical reactions to reminders of the trauma.

Criterion C: Avoidance

  • At least one of two symptoms must be present:

    • Avoiding thoughts or feelings related to the traumatic experience.

    • Avoiding people, places, and/or situations that trigger memories of the trauma.

Criterion D: Negative Mood and Cognitions

  • At least two of seven symptoms must be present:

    • Distorted blame (e.g., blaming oneself or others).

    • Persistent negative feelings (such as fear, anger, guilt).

    • Distance from others (feeling disconnected).

Criterion E: Hypervigilance

  • At least two of six symptoms must be present:

    • Being especially alert or watchful.

    • Exaggerated startle responses.

    • Sleep disturbances.

Additional Criterion

  • Criterion F: Symptoms must last at least one month.

  • Criterion G: Symptoms must cause significant distress within the individual, in their relationships, or at work.

  • Criterion H: Symptoms cannot be better explained by other circumstances (e.g., substance use, medical conditions).

History of Assessment of PTSD

  • Former Terminology: PTSD was once referred to as “Shell shock.”

  • First DSM Appearance: PTSD was first introduced in the DSM-III (APA, 1980).

  • Previous Classification: It was categorized as an anxiety disorder. In DSM-IV, criteria included a history of exposure to trauma and three symptom clusters: intrusive recollections, avoidant/numbing, and hyperarousal.

  • Criterion A Changes: The traumatic event needed to elicit intense fear, helplessness, or horror.

Current DSM-5-TR Standards

  • Placement: PTSD is now classified under Trauma- and Stress-Related Disorders.

  • Removed Symptoms: Emotional “numbing” has been removed from the diagnostic criteria.

  • Added Symptoms: The negative mood and cognitions cluster has been added.

  • Criterion A Expansion: Indirect trauma exposure has been included (e.g., learning about a trauma).

  • Emotional Reaction Removal: The requirement for intense fear, helplessness, or horror has been removed as a criterion.

Assessments of PTSD

  • Structured Interviews:

    • CAPS: Clinician Administered PTSD Scale

    • PSS-I: PTSD Symptom Scale – Interview

    • SCID: Structured Clinical Interview for DSM-5

    • SIP: Structured Interview for PTSD

  • Self-Report Measures:

    • PCL: PTSD Checklist

    • Mississippi Scale for Combat Related PTSD

    • DTS: Davidson Trauma Scale

    • PDS: Posttraumatic Stress Diagnostic Scale

    • TSQ: Trauma Screening Questionnaire

    • PC-PTSD-5: Primary Care PTSD Screen for DSM-5

  • Note: There are many additional assessments available.

Specific PTSD Assessments

1. LEC – Life Events Checklist

  • Nature: A self-report measure listing 17 types of stressful events.

  • Purpose: Individuals mark events they have experienced or witnessed and indicate how they felt about them.

List of Events in LEC

  1. Natural disaster (e.g., flood, hurricane, tornado, earthquake)

  2. Fire or explosion

  3. Transportation accident (e.g., car, boat, train, plane accidents)

  4. Serious accident at home, work, or during recreation

  5. Exposure to toxic substances (e.g., radiation)

  6. Physical assault (e.g., being attacked)

  7. Assault with a weapon (e.g., shooting, stabbing)

  8. Sexual assault (rape, attempted rape)

  9. Unwanted sexual experience

  10. Combat experiences / exposure to war-zone

  11. Captivity (e.g., kidnapping, hostage situations)

  12. Life-threatening illness or injury

  13. Severe human suffering

  14. Sudden violent death (e.g., homicide, suicide)

  15. Sudden accidental death

  16. Causing serious injury or death to someone else

  17. Other very stressful events

  • Response Options: Happened to me | Witnessed it | Learned about it | Part of my job | Not sure | Doesn’t apply

2. PCL – PTSD Checklist

  • Current Version: PCL-5, which assesses current symptoms aligned with DSM-5 criteria.

  • Format: A self-report measure including:

    • 20 questions (one for each symptom) on a Likert scale from 0 (Not at all) to 4 (Extremely).

    • Respondents indicate how much each symptom bothered them in the past month.

    • Important: Keep the most distressing traumatic event in mind when responding.

  • Scoring: 37 and below suggest likely no PTSD; 38 and above indicate likely PTSD (conservative cutoffs).

3. CAPS – Clinician-Administered PTSD Scale for DSM-5

  • Standard: Considered the gold standard for diagnosing PTSD.

  • Format: Structured interview with standardized prompts, but can include clarifying questions (e.g., “How well are you able to manage?”).

  • Scoring: Clinicians ask about the frequency and intensity of each symptom to derive an overall severity score for diagnosis.

    • Severity scores range from 0 (Absent) to 4 (Extreme).

    • Certain items assess whether symptoms are directly trauma-related to ensure an accurate diagnosis.

    • Reliability: Examiners must undergo training for standardization of scoring.

Specific Symptoms for Diagnosis

Intrusion Symptoms (Need 1 for Diagnosis)

  1. Intrusive Memories

  2. Distressing Dreams

  3. Dissociative Reactions

  4. Cued Psychological Distress

  5. Cued Physiological Reactions

Avoidance Symptoms (Need 1 for Diagnosis)

  1. Avoidance of memories, thoughts, feelings related to the event.

  2. Avoidance of external reminders of the trauma.

Cognitions and Mood Symptoms (Need 2 for Diagnosis)

  1. Inability to recall important aspects of the trauma.

  2. Exaggerated negative beliefs or expectations.

  3. Distorted beliefs leading to self-blame.

  4. Persistent negative emotional state.

  5. Diminished interest or participation in activities.

  6. Detachment or estrangement from others.

  7. Persistent inability to experience positive emotions.

Arousal and Reactivity Symptoms (Need 2 for Diagnosis)

  1. Irritable behavior and angry outbursts.

  2. Reckless or self-destructive behavior.

  3. Hypervigilance.

  4. Exaggerated startle response.

  5. Problems with concentration.

  6. Sleep disturbances.

Factors in Assessment

  • Consideration of Age: Assess when trauma occurred (childhood vs. adulthood).

  • Symptom Parsing: Differentiating between symptoms of negative emotions versus negative beliefs about self is crucial for coding.

  • Response Styles: Noted as “Global Validity” in CAPS assessments.

Comorbidities with PTSD

  • Comorbidity likelihood with other disorders includes:

    • Depression

    • Substance Use Disorder

    • Suicide risk

    • Other anxiety disorders

    • Traumatic Brain Injury (TBI)

    • Reference: Brady, Killeen, Brewerton, & Lucerini (2000)

Neurobiological Effects of PTSD

  • Amygdala: Increased activity corresponds with heightened emotional reactions.

  • Hippocampus: Decreased activity and reduced volume which affects memory formation.

  • Prefrontal Cortex: Reduced volume linked to impaired decision-making and emotional regulation.

  • Stress Hormones:

    • Decreased serotonin levels.

    • Increased dopamine levels.

  • Reference: Sherin & Nemeroff (2011) regarding neurobiological impacts of psychological trauma.

Evidence-Based Treatments for PTSD

  1. Prolonged Exposure (PE): Involves confronting memories and situations that have been avoided since the trauma.

  2. Cognitive Processing Therapy (CPT): Focuses on changing negative thoughts about the trauma.

  3. Eye Movement Desensitization and Reprocessing (EMDR): Involves thinking about distressing images and feelings while engaging in rapid eye movements to alter reactions to trauma memories.