Core Symptom Assessment of PTSD

Once the presence of a traumatic event has been established and it appears that the patient's problems are contiguous with the event, the presence, intensity, and duration of the core symptoms of PTSD need to be evaluated.

Is the patient demonstrating reexperiencing phenomena occurring in at least one of the following ways?

1. The patient experiences recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note that in young children, repetitive play may occur in which themes related to the event are reflected.

2. The patient experiences recurrent distressing dreams of the event. Note that in children, there may be frightening dreams without recognizable content.

3. The patient acts or feels as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note that in young children, trauma-specific reenactment may occur.

4. The patient experiences intense psychological distress at exposure to internal or external cures that symbolize or resemble an aspect of the traumatic event.

5. The patient experiences physiological reactivity on exposure to internal or external cures that symbolize or resemble an aspect of the traumatic event.

Is the patient experiencing persistent avoidance of stimuli associated with the trauma and a numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following?

1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma.

2. Efforts to avoid activities, places, or people that arouse recollections of the trauma.

3. Inability to recall an important aspect of the trauma.

4. Markedly diminished interest or participation in significant activities.

5. Feeling of detachment or estrangement from others.

6. Restricted range of affect (e.g., unable to have loving feelings).

7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).

Finally, is he or she experiencing persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following?

1. Difficulty falling or staying asleep.

2. Irritability or outbursts of anger.

3. Difficulty concentrating.

4. Hypervigilance.

5. Exaggerated startle response.

Norris and Hamblen (2004) also reviewed 17 instruments relevant to assessing the core symptoms of PTSD. Some strong instruments identified are the Posttraumatic Stress Diagnostic Scale, developed by Foa, Cashman, Jaycox, and Perry (1997) and the PTSD-Interview (PTSD-I), developed by Watson et al. (1991). The Posttraumatic Stress Diagnostic Scale inquires about DSM-IV symptoms occurring within the last month. Both validity (alpha = .92) and reliability (r = .83) are considered solid. The PTSD-I was developed for veterans, but Norris and Hamblen state it could be used for almost any population. The DSM-IV symptoms are identified as existing on a seven-point scale, ranging from "no" to "extremely" or "never" to "always." Again, validity (alpha = .92) and reliability (test-retest reliability = .95) are considered solid. The Mississippi Scale for Combat-Related PTSD is an empirically developed instrument specifically designed to assess PTSD in veterans but has been used with civilians and women as well. It is considered a good general measure of PTSD. Finally, the Impact of Event Scale-Revised has been identified as a useful and simple measure to assess the core PTSD symptoms across a range of different samples.

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