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Assessment of Posttraumatic Stress Disorder

During the past decade, the literature devoted to the clinical assessment of PTSD advanced considerably. Of particular note is the increase in attention to the development of assessment tools for use with noncombatants and even more specifically with survivors of specific civilian traumas (e.g., tools developed specifically for use with rape survivors, crime victims, etc.), the increase in the number of tools available for use with children, as well as the progress that has been made toward understanding the neurobiological factors that may contribute to the development and maintenance of PTSD.
However, because there is still no one absolute diagnostic measure of PTSD, stateof-the-art and comprehensive assessment of PTSD uses a multiaxial, multimodal approach. The term multiaxial denotes that multiple sources of information are used in the assessment process (e.g., clinical interview, collateral report, self-report inventories). To capture the nature and extent of dysfunction more fully, a multimodal approach is used to access selected response modalities that have demonstrated utility in measuring the anxiety construct and specifically PTSD (e.g., overt behavioral responses, subjective responses, physiological responses, cognitive/neuropsychological status). The ultimate goals of this comprehensive assessment of PTSD are to identify signs and symptoms of the disorder, as well as comorbid disorders; to determine factors that have contributed to the development of the disorder, as well as factors that maintain current symptoms; to gain an understanding of an individual’s functional status; and to establish a baseline against which to gauge treatment gains. The use of a multiaxial, multimodal assessment protocol allows the determination of a DSM-IV diagnosis, as well as further functional analysis, to specify the behavioral, cognitive, and physiological excesses and deficits displayed by an individual who meets diagnostic criteria.
Generally, the multiaxial, multimodal assessment approach should be used to gather converging data to indicate the presence of clinically significant symptoms of PTSD. The possibility of monetary compensation for PTSD makes the issue of assessment validity a paramount concern for clinicians who conduct PTSD evaluations. Every effort should be made to ensure that multiple data corroborate the diagnostic impression. Additionally, when assessing for PTSD, it is most important to remember that symptoms of PTSD show considerable overlap with other diagnostic categories. Consequently, the diagnostician must strive to determine that symptoms are manifest in response to experiencing a traumatic event and that the current level of functioning represents a change, compared to functioning before the traumatic experience. Furthermore, the clinical evaluator should be aware that the symptom picture presented can vary as a function of the amount of time that elapsed since the trauma.
The clinician should also be sensitive to the differences in the symptom picture and the response to trauma displayed by various racial and cultural groups, as well as those displayed in response to different types of traumas (e.g., repeated sexual abuse vs. a single automobile accident). Finally, when assessing children, the evaluator should make every effort to tailor the selection and use of assessment tools to the developmental level of the child being assessed. Practical considerations may dictate using a more streamlined approach to assessing PTSD. Likewise, a comprehensive assessment battery that uses the full array of available tools may not be required in all situations. Nonetheless, numerous components are available to choose from in selecting an assessment protocol to meet the requirements of a specific context, and using the most comprehensive assessment battery possible is generally recommended in any given situation.
It is beyond the scope of the current chapter to review in any detail the large number of relevant assessment tools that have been developed and refined in the last decade, but we present information to introduce the reader to the following types or categories of assessments that can be used in a PTSD assessment battery: structured clinical interviews, self-report psychometric rating scales, clinician rating scales, psychophysiological assessment, and neurobiological and neuropsychological assessments. For a more complete treatment of the broad range of issues surrounding the assessment of PTSD, we refer the reader to several other excellent sources that address these issues and describe specific assessment instruments in more detail.

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