Assessment and Diagnosis of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a chronic and debilitating mental condition that develops in response to catastrophic life events, such as military combat, sexual assault, and natural disasters. The symptoms of PTSD are divided into 3 symptom clusters: reexperiencing, avoidance, and hyperarousal. In addition, trauma survivors often experience guilt, dissociation, alterations in personality, difficulty with affect regulation, and marked impairment in ability for intimacy and attachment.^1,2 Disorders comorbid with PTSD include depression, substance abuse, other anxiety disorders, and a range of physical complaints.^3,4

Over the past several decades, considerable progress has been made in the development and empirical evaluation of assessment instruments for measuring trauma exposure and PTSD as well as related syndromes, such as acute stress disorder. The measures that have been developed, including questionnaires, structured interviews, and psychophysiological procedures, have been extensively validated and many have been widely adopted internationally. PTSD assessments were developed to be psychometrically sound; to collect information from multiple sources across response channels; and to use across different trauma populations, settings, genders, ethnic groups, and cultures.^5-8

This article, based on a comprehensive review by Weathers and associates,⁹ provides a selective and brief summary of trauma and PTSD assessments in adults.

Diagnosing PTSD

The current diagnostic criteria for PTSD include¹⁰:

• Exposure to a traumatic stressor (criterion A)

• The development of a characteristic syndrome involving reexperiencing, avoidance and numbing, and hyperarousal symptoms (criteria B through D)

• Duration of at least 1 month (criterion E)

• Clinically significant distress or impairment in social or occupational functioning (criterion F).

A comprehensive assessment of PTSD evaluates all of the diagnostic criteria, assesses associated features and comorbid disorders, and establishes a differential diagnosis. Although some of these tasks can be accomplished with self-report measures, most are best accomplished with a structured interview. Clinical interviews provide opportunities to ask follow-up questions, to clarify items and responses, and to use clinical judgment in making the final ratings.

It is necessary to establish that an individual has been exposed to an extreme stressor that satisfies the DSM-IV definition of trauma as described in criterion A. The patient must have directly experienced the event, witnessed it, or learned about it indirectly; the event must have been life-threatening, involved serious injury, or threatened physical integrity; and it must have triggered an intense emotional response of fear, horror, or helplessness.

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