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Assessments of Trauma History

Because the hallmark symptom of PTSD is exposure to a traumatic event, it is crucial that any assessment of PTSD determine that exposure has occurred. Researchers and clinicians have not yet reached a consensus regarding how best to identify and characterize events that meet the diagnostic criteria for traumatic event exposure as specified in DSM-IV. Approaches to developing instruments to assess the nature and level of exposure to trauma have focused variously on identifying the type of event, characterizing the degree or level of exposure, defining characteristics of the events that are purportedly related to poorer outcome, and determining the subjective response of an individual to an event.
Currently, DSM specifies that a traumatic event is defined both by the objective characteristics of an event and the subjective response to that event. At present, however, there are few published instruments designed to assess trauma history that assess both the objective characteristics and the subjective reaction to the event. Additionally, it should be noted that more formalized and quantitative assessments of trauma histories are at times incorporated into clinical interviews (e.g., the CAPS).
To provide a f lavor of the type of instruments available for use as ‘‘stand-alone’’ trauma assessments, we review here two widely used instruments that represent different approaches to trauma assessment: (1) the Potential Stressful Events Interview that assesses exposure to a broad array of potentially traumatic events and is designed to provide an assessment that corresponds with the DSM-IV definition of a traumatic event and (2) the Combat Exposure Scale that is limited to assessing combat-related traumatic events and does not attempt to provide results that correspond to the current DSM conceptualization of traumatic events. For a more complete treatment of instruments that assess trauma history, we refer the reader to Friedman, Newman et al. The Potential Stressful Events Interview was developed initially for use in the DSM-IV PTSD f ield trial. This interview gathers information on exposure to low magnitude stressors and high magnitude stressors, as well as objective and subjective information on high magnitude stressors. The interview inquires about experiencing a broad array of potential traumatic events using wellcrafted and direct language. This instrument is used quite widely, but currently there is no reliability or validity information published on it. Additionally, the detail obtained by using this instrument requires considerable time and effort that may prove prohibitive in some situations. In an effort to address the issue of burden, researchers have developed a brief self-report instrument that is based on the PSEI—the Trauma Assessment for Adults. Using the TAA may be more feasible when time availability for gathering information is a primary consideration—such as community epidemiologic studies. One of the most rigorously tested measures of combat exposure is the Combat Exposure Scale.
The CES was partly derived from Figley’s combat scale, and additional items were constructed by PTSD content experts. Individuals who complete the scale rate items that describe various types of combat-related experiences on a Likert scale, and ratings are totaled to yield a range of possible scores between 0 and 41. Items are weighted in determining the total score based on the severity of the combat experience described by the item. This scale has demonstrated good internal consistency (coefficient alpha = .85), high test–retest reliability (r = .97), and some concurrence with measures of PTSD. Although this scale was developed initially for use with Vietnam veterans, item content is not exclusive to Vietnam combat experiences, and it has been adapted for use with veterans of the Persian Gulf War, as well as soldiers who served in Somalia and Bosnia. Note that this measure does not have validity indicators, thus highlighting the importance of corroborating results obtained with other sources of information.

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