PhenX Protocol: PTSD Symptoms, Severity, and Diagnosis - DSM 5 (#630402). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is available from the. Mechanisms of PTSD are not well understood so we limit our investigation to discriminative approaches. In contrast to the current gold standard for diagnosis, (the. Clinician Administered PTSD Scale (CAPS) (Blake et al. 1995)) which is computed from a clinician-coded structured clinical interview, we propose a diagnostic.
CAPS-1 DSM III Published in 1990 Assessed 17 symptoms of PTSD in the DSM III-R 8 associated symptoms 5 additional items CAPS-5 Structured interview Assesses lifetime PTSD diagnosis, current PTSD diagnosis, and PTSD symptoms in the past week Changes in CAPS assessment CAPS for DSM-IV ----->CAPS 5 (DSM 5) Single index trauma 30 item questionnaire Single severity score Test Considerations Requires the identification of at least one traumatic event. Score calculations have been seen as repetitive. Clinician-Administered PTSD Scale (CAPS-5) Questions Onset & duration Social and occupational impact Subjective distress Dissociative symptoms Overall severity of PTSD Can be used as a 'check-in' tool with clients. Severity Ratings Absent (0) Mild/Sub-threshold (1) Moderate/Threshold (2) Sever/Markedly Elevated (3) Extreme/Incapacitating (4) Post Traumatic Stress Disorder (PTSD) Who can experience PTSD?
Things to consider when working with clients with a possible PTSD diagnosis: Reluctancy to share traumas Re-traumatizing the victim Conflict between establishing trust & encouraging the client to talk Time boundaries Demeanor Emotional regrouping Background Information References American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association Author. D., Weathers, F. M., Kaloupek, D. G., Gusman, F. D., Charney, D.
S., & Keane, T. The development of a clinician-administered PTSD scale.
(PDF) Journal of Traumatic Stress, 8, 75-90. Doi: 10.1002/jts. National Center for PTSD. Clinician-administered PTSD scale for DSM-5 (CAPS-5). Retrieved from www.ptsd.gov Roffer, W. DSM-5: Assessment and treatment of PTSD [Powerpoint document].
Retrieved from Sommers-Flannagan, J., & Sommers-Flanagan, R. Clinical interviewing (5th ed.). Hoboken, NJ: John Wiley & Sons, Inc.
1National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs Boston Healthcare System, Boston, MA; 2Boston University School of Medicine, Boston, MA Abstract — The psychometric properties of the PTSD Checklist (PCL) were investigated in a sample of treatment-seeking and community-dwelling male veterans. In conjunction with previous reports, results from the present study indicate that the PCL possesses strong, robust psychometric properties. The current investigation suggests a cutoff score of 60-higher than previous investigations-related to posttraumatic stress disorder (PTSD) diagnosis derived from the Clinician-Administered PTSD Scale. This research supports the use of the PCL as a brief self-report measure of PTSD symptomatology.
Key words: Clinician-Administered PTSD Scale, Combat Exposure Scale, Evaluation of Lifetime Stressors, mental health symtomatology, PCL, potentially traumatic event, psychometric validation, PTSD, rehabilitation, self-report measure, veterans. Abbreviations: CAPS = Clinician-Administered PTSD Scale, CES = Combat Exposure Scale, DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders-Third Edition-Revised, DSM-IV = DSM-Fourth Edition, ELS = Evaluation of Lifetime Stressors, ELS-I = ELS interview, ELS-Q = ELS self-report questionnaire, Mississippi Scale = Mississippi Scale for Combat-Related PTSD, NPV = negative predictive value, PCL = PTSD Checklist, PPV = positive predictive value, PTE = potentially traumatic event, PTSD = posttraumatic stress disorder, SD = standard deviation, VA = Department of Veterans Affairs. INTRODUCTION Since its introduction in 1993, the PTSD Checklist (PCL) has been widely used in research and clinical settings.
The original validation study [1] was presented at the annual meeting of the International Society for Traumatic Stress Studies but was never published, potentially limiting its accessibility to individuals wanting to use or accurately cite the instrument. In the present study, we replicated Weathers et al.' S investigation [1] in a sample of male veterans similar to that used in their initial validation. Furthermore, the current validation of the PCL is based on the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) [2], whereas Weathers et al. [1] used the DSM-Third Edition-Revised (DSM-III-R) criteria [3]. The PCL is a 17-item self-report measure of posttraumatic stress disorder (PTSD) symptomatology.
Respondents indicate the extent to which they have been bothered by each symptom in the past month using five-point Likert scales with anchors ranging from 'Not at all' to 'Extremely.' Different scoring procedures may be used to yield either a continuous measure of PTSD symptom severity or a dichotomous indicator of diagnostic status. Dichotomous scoring methods include either an overall cutoff score or a symptom cluster scoring approach. The symptom cluster scoring method corresponds to the DSM-IV diagnostic criteria [2], typically requiring a score of 3 ('Moderately') or greater on one cluster B symptom (reexperiencing), three cluster C symptoms (avoidance/numbing), and two cluster D symptoms (hyperarousal).
Currently two versions of the PCL exist: a military version, in which reexperiencing and avoidance symptoms apply to military-related stressful experiences only, and a civilian version, in which reexperiencing and avoidance symptoms apply to any stressful experience. In addition, a number of researchers have developed and used study-specific versions of the PCL, in which reexperiencing and avoidance symptoms apply to a stressful experience (e. Buddha In Daily Life Pdf File more. g., sexual assault, motor vehicle accident) that is specified by the experimenters. In the original validation study of an earlier version of the PCL, Weathers et al.
Examined the psychometric properties of the PCL in veterans of the Vietnam and gulf wars [1]. Their findings are summarized in Table 1, along with 19 other reports.
Since the introduction of the PCL, additional studies have evaluated its psychometric properties [4-5] and examined its utility as a screening instrument for PTSD symptoms within specific clinical populations [6-7]. The findings from these studies, summarized in Table 1, offer strong evidence for the reliability and validity of the PCL within the samples investigated. Taken together, these studies support the utility of the PCL as a brief self-report screening instrument to assess for the presence of PTSD symptoms.
Previous reports on psychometric properties of PCL. Different Cutoff Scores Across Samples One discrepancy that has been noted across studies concerns the optimally efficient cutoff score for differentiating people with and without PTSD. Weathers et al.
Reported that a cutoff score of 50 optimized specificity and sensitivity of the PCL in their sample of Vietnam and gulf war veterans [1]. The majority of subsequent studies, however, have suggested that lower cutoff scores more accurately identify individuals with PTSD ( Table 1). Noting their lower optimal cutoff score of 44 in a sample that was mostly female and recently exposed to a potentially traumatic event (PTE), Blanchard et al. Suggested that gender and/or time since a PTE may influence reporting style, resulting in different optimal cutoff scores across samples [4]. Others have suggested that factors such as severity of PTE exposure and treatment-seeking status may be associated with these differences [8].
However, given the lack of studies using diverse and/or mixed samples to test these hypotheses, definitively answering these questions is not possible at this point. The determination of the most appropriate cutoff depends not only on the clinical population but also on the goals of the assessment. For example, a lower cutoff score may be preferable in situations in which the goal is to identify all possible cases of PTSD (e.g., for clinical screening purposes), while a higher cutoff score may be more appropriate when excluding individuals who do not meet criteria for PTSD is important (e.g., for research purposes).
Present Study The present study addresses several deficiencies and limitations in the PCL research literature. As illustrated in Table 1, while several studies have reported on various psychometric properties of the PCL, clearly none has conducted as thorough an investigation as the unpublished Weathers et al. Study [1], which included measures of internal consistency, test-retest reliability, convergent validity, comparison to a gold standard, and factor structure. In the present study, we address these limitations by providing a more comprehensive investigation of the psychometric properties of the PCL in a sample of male veterans. Furthermore, we suggest that the utility of the PCL be considered within the context of the assessment environment, including clinical settings, research studies, and veteran-based compensation and pension evaluations. Participants Participants were 114 male veterans who had participated in a larger study conducted at the National Center for PTSD in the Department of Veterans Affairs (VA) Boston Healthcare System [9].
Participants were recruited from the VA Boston Healthcare System and from the surrounding New England community via newspaper advertisements and posted flyers. All data were collected at the National Center for PTSD. At the time of their enrollment, participants were informed that the purpose of the study was to develop more accurate and reliable psychological evaluations for lifetime stressors. We included both treatment-seeking veterans and individuals recruited from the community in an effort to increase variability with respect to PTE exposure and mental health symptomatology (see Table 2 for a breakdown of PTEs by event type).
Potential participants were excluded if they were actively psychotic, suicidal, homicidal, or unable to refrain from substance use for 24 hours before and during the study. Participants ranged in age from 29 to 65 years (mean ± standard deviation [SD] = 47.4 ± 7.1).
Twenty-five participants (21.9%) met the diagnostic criteria for PTSD. Additional demographic information is presented in Table 3. An additional 10 participants did not complete the protocol, failing to return for the second and/or third session; therefore, their data were excluded from all analyses. Participants' self-report of exposure to potentially traumatic events ( N = 114). Measures Participants completed the PCL (civilian version) to ensure the applicability of items to both combat and noncombat PTEs. Spanish Composition Through Literature 6th Edition. In accordance with the initial development and validation of the PCL, participants' responses were not based on a specific PTE. In addition, they completed the measures of PTE exposure and PTSD symptoms outlined in the following sections.
In general, very few values were missing in this data set. Specifically, regarding the PCL data, only 2 of 1,938 data points were coded as missing. These 2 missing values were excluded from the computation of summary statistics used for later analysis. As a general guideline, instruments were included in analyses if less than 10 percent of the items were missing.
Clinician-Administered PTSD Scale The Clinician-Administered PTSD Scale (CAPS) is a structured clinical interview that measures the frequency and intensity of the 17 PTSD symptoms [10] outlined in the DSM-IV [2]. Each symptom is assessed on a 5-point Likert scale, with higher scores indicating more severe PTSD symptoms. In addition, a dichotomous scoring system can be used to indicate whether or not a respondent meets the diagnostic threshold for PTSD. The present study used the 'Frequency >1/Intensity >2' scoring rule, in which an item is considered to meet the threshold for a PTSD symptom when its frequency is rated as 1 or higher and its intensity as 2 or higher. This was the original scoring rule proposed by Blake et al.
[10] and is commonly used in research and clinical settings. The CAPS has repeatedly demonstrated strong and robust psychometric properties and is considered the current gold standard for PTSD diagnosis [11-12]. Mississippi Scale for Combat-Related PTSD The Mississippi Scale for Combat-Related PTSD (Mississippi Scale) is a brief self-report measure that assesses the presence and severity of PTSD symptoms and associated features [13]. This instrument, composed of 35 items measured on a 5-point Likert scale, is widely used with veteran populations and has demonstrated strong psychometric properties [13]. The Mississippi Scale has three versions: a military version referring specifically to military-related PTEs; a civilian version referring to any type of PTE; and a collateral version, in which a partner or significant other reports on the individual's symptoms. In the present study, we used the civilian version of the Mississippi Scale to ensure the applicability of items to either civilian or military PTEs.
In accordance with the development and typical use of this instrument, participants were not instructed to complete it with a specific PTE in mind. Procedure Data were collected over the course of three sessions within a 1-week interval. The self-report measures (PCL, Mississippi Scale, and CES) were completed during the initial session, the ELS was administered during the second and third sessions, and the CAPS was completed during the third session. Participants provided informed consent at the time of enrollment in the initial study, and their data were archived with all identifying information removed. After obtaining approval from the institutional review board of the VA Boston Healthcare System, we analyzed these deidentified data to replicate and extend previous research on the psychometric properties and validity of the PCL. RESULTS Based on data from the ELS interviews, results indicated that participants reported from 2 to 24 lifetime PTEs (mean ± SD = 11.1 ± 5.3), ranging from 0 to 13 childhood PTE types (mean ± SD = 4.8 ± 3.0) and 1 to 13 adulthood PTE types (mean ± SD = 6.3 ± 3.1). Additional information with respect to PTE-type exposure is presented in Table 2.
PCL scores ranged from 17 to 71 (mean ± SD = 33.0 ± 15.5) for individuals without PTSD and from 26 to 81 (mean ± SD = 57.0 ± 15.9) for those with PTSD. An independent samples t-test revealed a significant difference between mean PCL scores for those with and without a PTSD diagnosis ( t(112) = 6.83, p. Diagnostic Utility A receiver operator characteristic curve is a graphical representation of the trade-off between sensitivity (the probability that a condition that is present will be detected) and specificity (the probability that a condition that is absent will not be detected). The Figure shows the false positive rate (1 - specificity) on the x-axis and the true positive rate (sensitivity) on the y-axis. Values near the upper left corner of the curve maximize both sensitivity and specificity. The area under the curve is a measure of the overall accuracy, with a larger area (i.e., a maximum of 1.00) indicating more accuracy.
For the PCL, the area under the curve was 0.86. We examined PCL scores in the range of 43 to 71, using CAPS PTSD diagnosis as the criterion measure. We examined three measures of diagnostic value: sensitivity, specificity, and diagnostic efficiency (the proportion of cases correctly diagnosed). These values are presented in Table 5. The optimally efficient cutoff score was 60, which yielded a sensitivity of 0.56, a specificity of 0.92, and a diagnostic efficiency of 0.84.
Sensitivity, specificity, and accuracy of potentially optimal PTSD Checklist (civilian version) cutoff scores in identifying individuals with PTSD ( N = 114). Optimally efficient cutoff was 60 (shown in bold).