Background and History

When working with PTSD patients, the first order of business is to get a trauma history to determine whether a traumatic event has occurred. Simply ask the patient when his or her symptoms and problems began. Next, ask if he or she has been exposed to a traumatic event or stressor per the DSM-IV-TR criteria: "Have you ever experienced, witnessed, or been confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of you or others?"

Clinician Alert

The phrasing of this question is an extremely important issue. If this question is asked too formally, patients might get confused. It always helps to ask the question in a language the patient can understand. Sometimes it is better to just ask, "Have you ever almost died?" or "Have you ever seen anyone get killed or die right in front of you?" These questions are fairly specific and, therefore, might not cover the range of qualified traumatic stressors, but they are often useful in stimulating the patients' thinking about traumatic events in their lives. They might bring up events or examples that don't qualify in a strict sense, but all responses to this question should be investigated further. If an event is salient enough to produce trauma symptoms, simple questions will often stimulate patients just enough to yield good information.

If there was an event or events, are the symptoms or problems contiguous with the event or stressor? Also, ask about past traumatic events that occurred long before the appearance of symptoms or dysfunction. Patients' recollections of when signs and symptoms began are not always accurate, and their difficulties may have begun much earlier than they realize. Careful and thorough questioning will help pinpoint when signs and symptoms began and whether they appear to be related to a traumatic event.

Background and history information relevant to a trauma history can be ascertained in any number of ways, ranging from structured clinical interviews, questionnaires, nonstructured clinical interviews, and standardized self-report measures. Norris and Hamblen (2004) reviewed seven quality self-report measures designed to ascertain the presence of qualified traumatic events in a patient's history. Two standout instruments are both questionnaires: the Traumatic Life Events Questionnaire (TLEQ), developed by Edward Kubany et al. (2000) and the Stressful Life Events Questionnaire (SLESQ), developed by Goodman, Corcoran, Turner, Yuan, and Green (1998). The TLEQ assesses the occurrence of 23 traumatic events (e.g., natural disasters, motor vehicle accidents, or combat), is useful for both research and clinical practice, is clinician-administered, and has good psychometric properties. It is a comprehensive questionnaire covering a wide range of traumatic events. The SLESQ is a self-report screening instrument that assesses lifetime exposure to potentially traumatic events and, like the TLEQ, has good reliability statistics. It provides such useful information as the age, frequency, and degree of life threat of a particular trauma.

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