Evaluation And Assessment of PTSD

So far we have discussed the general issues of psychological evaluation and assessment that are important for any and all psychological and psychiatric problems. We now turn specifically to the evaluation and assessment of PTSD. Although the clinical evaluation of PTSD should be similar to the evaluation of other disorders, there are specific issues, approaches, and techniques especially relevant to PTSD. This is important to consider because a generic approach to the assessment of PTSD might leave many questions unanswered and ultimately lead to a client or patient not receiving the help he or she needs. John Wilson (2004) proposes a very useful and comprehensive approach to the evaluation and assessment of PTSD in order that these issues might be avoided. Wilson's (2004) comprehensive model of assessment includes two large areas of assessment, symptom clusters and adaptive behavioral considerations. There are five symptom clusters: (1) reexperiencing, (2) avoidance, numbing, and coping, (3) hyperarousal, (4) self and ego, and (5) interpersonal affiliation patterns of attachment, bonding, intimacy, and love. The adaptive behavioral configurations include dysregulated affects, personality alterations (self, ego, etc.), altered interpersonal processes (detachment, loss of intimacy, alienation), psychosocial functioning (school, work, etc.), comorbidity, health, life-course trajectory (changes in epigenetic developmental patterns), and recovery and healing. Using Wilson's approach, comprehensive assessment with the PTSD patient should involve measuring each of the areas listed. Wilson calls his approach an organismic approach encompassing the complete functioning of an individual's biopsychosocial functioning. Specifically, a complete assessment involves an encompassing set of psychological and psychosocial functions, such as are presented in the following:

1. Addressing of the etiology of the disorder in the five subsystems and affected functioning for a particular patient or client.

2. Understanding the changes in pretraumatic baseline functioning.

3. Assessment of profile configurations in terms of frequency, periodicity, severity, intensity, and duration of symptoms within the five clusters.

4. Knowledge of how core inner dimensions of the self are altered in ways that are associated with posttraumatic self-typologies that fall along a continuum of fragmentation to integration and transformation.

5. Understanding of how the trauma has affected his/her biopsychosocial functioning in terms of epigenetic development and personality functioning in the life cycle.

Also included in Wilson's model is a comprehensive trauma history, a prior history of abuse, victimization, and an evaluation of preexisting Axis I or II disorders.

Newman, Kaloupek, and Keane (1996) also suggest a comprehensive and mul-timethod approach to the clinical evaluation and assessment of PTSD. They state, "The challenge in the clinical assessment of PTSD is to combine appropriate measure so as to distinguish individuals who, once exposed to potentially traumatic events, have gone on to develop the disorder from those who have not" (p. 245). They promote a flexible approach that yields the highest level of diagnostic utility, that is, the extent to which a particular assessment approach or instrument accurately differentiates one group from another. Test batteries are suggested to maximize sensitivity and the power of the assessment process. Unfortunately, there has been no specific battery of instruments identified for PTSD. At this point, battery construction is left up to the individual clinician or researcher for his or her particular purposes.

Newman et al. (1996) recommend using a comprehensive structured or semi-structured interview in order to "insure that all PTSD symptomatology is reviewed in detail" (p. 247). The strength of a semistructured format over a structured one is its flexibility while maintaining its structure. A weakness of this method is its dependence on the clinical skill of the administrator. Another component of the multimethod approach is the self-report measure, providing a patient's eye view of their experience and symptoms. A third component to the multimethod approach is the use of empirically derived psychometric measures of PTSD. Finally, psychometric instruments not specifically designed for PTSD but that can help in assessing other concomitant issues can be employed, such as the MMPI-2, the Beck Anxiety Inventory, or the various Wechsler scales of intelligence and memory.

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