Psychological Symptoms
PTSD symptoms. For many veterans, a diagnostic label may not be needed & may not facilitate treatment. In some circumstances,
applying such a label may be counterproductive & undesirable to the veteran.
A brief measure of PTSD symptoms can, however,
be useful to get an idea of current PTSD symptoms a veteran might be having & to monitor treatment progress. A wide variety
of brief measures of PTSD symptoms are available & information about these (including
contact information to obtain measures) can be found at:
www.ncptsd.org/publications/assessment
(note: I tried the above link but couldn't find anything)
Additional information about measures of PTSD
can be found in Briere (1997), Carlson (1997), Solomon
et al. (1996) & Wilson & Keane (1996).
For convenience, 2 brief measures are included in this appendix here: the
Posttraumatic Checklist - Civilian (PCL-C) & the Screen for Posttraumatic Stress Symptoms
(SPTSS). Both are measures that don't key symptoms to a particular event since exposure
to multiple events is common & it isn't clear that people can assign symptoms to events
with any accuracy or that symptoms are, in fact, uniquely associated with particular events.
The PCL-C is recommended rather than the
PCL-Military because it's important to assess veterans’ responses to military & non-military traumatic events when
assessing for treatment purposes.
The SPTSS may be useful with veterans who
have less formal education because it has a very low reading level. It may also be useful for veterans who are reluctant to
report distress because it inquires about the frequency of symptoms rather than the degree of distress they cause.
If assignment of a diagnostic label is required or desired, the clinician
Administered PTSD Scale (CAPS) (Weathers,
Keane, & Davidson, 2001) can be used. Detailed information about this structured interview & how to obtain
it are available at:
http://www.ncptsd.org/publications/assessment/ncinstruments.html
(note: I tried the above link but couldn't find anything)
Dissociation. Dissociative
symptoms are very common in trauma survivors & they may not be spontaneously reported. The Trauma-Related Dissociation
Scale (Carlson & Waelde, 2000), a measure of dissociation, is included in this appendix.
Depression. Depression
is a very common comorbid condition in those with posttraumatic disorders. It may be secondary
to PTSD or associated with aspects of traumatic events such as losses. The Beck Depression
Inventory (BDI) – Short Form is a common brief measure of depression & is included
in the appendix (Beck & Steer, 2000).
This measure is also available for computerized
administration via DHCP at VA Medical Centers.
Traumatic grief. Screen for Complicated Grief is a brief measure of symptoms of traumatic grief & is included in this appendix.
Further details about the construct this screen measures can be found in Section VI of this Guide.
Alcohol use. Substance
use is a common problem for those with PTSD, particularly alcohol abuse & dependence.
The AUDIT (Goldman, Brown & Christiansen, 2000) is a screen for alcohol use that's included
in this appendix.
Other domains to assess & suggested measures:
Anger. Anger
is a frequent problem for trauma survivors & outbursts of anger is a symptom of PTSD.
If a veteran reports problems with anger, detailed assessment of that area may be useful.
The State-Trait Anger Expression Inventory (STAX-I) is measure of anger &
how it's expressed (Spielberger, 1988). This measure may be useful to assess vets, although
it's important to note that it isn't ideal to assess recent, post-trauma anger because its trait form assesses both pre-trauma
& post-trauma anger & its state form assesses feelings at the time of the assessment (which
may not representative of the entire post-trauma period).
Guilt & shame. Guilt & shame
are frequently issues for trauma survivors who feel distressed over what they did or didn't do at the time of trauma. Kubany et al. (1995) have developed
a measure of guilt that may be useful to assess those with clinical issues in that domain.
Relevant History
Exposure to potentially traumatic events. Because exposure to previous traumatic stressors may affect response to traumatic stressors experienced in the military, it's important to broadly assess exposure to traumatic stressors.
The Trauma History Screen (Carlson, 2002), a brief assessment tool that can be used for that purpose, is included in this appendix.
Selected scales within the Deployment Risk & Resilience Inventory (DRRI; King, King, & Vogt, 2003) may be used as a vehicle to identify particular combat &
other high magnitude & threatening experiences that were potentially traumatic.
Because the level of non-traumatic stressors & the overall context in
which exposure to traumatic stressors occurs may affect the response to high magnitude stressors, it's important to assess these elements.
Several scales from the DRRI (e.g., concerns about life & family disruptions, difficult living & working environment, war-zone social support)
may prove useful to gain a broader profile of the deployment experience.
Copies of the individual DRRI measures, scoring guides & a full manual
describing instrument development may be obtained by contacting dawne.vogt@med.va.gov.
For women veterans. Because women who serve in the military may be exposed to a number of traumatic stressors that aren't assessed in combat measures, specific assessment of military stressors is often helpful for women veterans.
Life Stressors Checklist (Wolfe & Kimerling, 1997) is provided in this appendix for this purpose.
For each statement below,
circle 1 of the choices to show how many times each thing has happened to you in the past week.
- not at all: 1
- once or twice: 2
- 3-6 times: 3
- 7-10 times: 4
- more than 10 times: 5
1. My body felt strange or unreal.
2. Things around me seemed strange or unreal.
3.
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Instructions: Below is a list of problems & complaints that people
sometimes have in response to stressful life experiences. Please read each one carefully, then circle one of the numbers to the right to indicate how much you've
been bothered by that problem in the past month.
Key: #1 - not at all
# 2 - a little bit
# 3 - moderately
# 4 - quite a bit
# 5 - extremely
2. Repeated disturbing dreams from an experience in the past? 1 2 3 4 5
3. Suddenly acting of feeling as if a stressful experience was happening again (as if you were re-living it)? 1 2
3 4 5
4. Feeling very upset when something reminded you of a stressful experience from the past? 1 2 3 4 5
5. Having physical reactions (heart pounding, trouble breathing, sweating)
when something reminded you of a stressful experience from the past? 1 2 3 4 5
7. Avoiding activities or situations because they reminded you of a stressful experience from the past? 1 2 3 4 5
8. Trouble remembering important parts of a stressful experience from the past? 1 2 3 4 5
9. Lost of interest in activities that you used to enjoy? 1 2 3 4 5
12. Feeling as though your future will somehow be cut short? 1 2 3 4 5
15. Having difficulty concentrating? 1 2 3 4 5
16. Being "super alert" or watchful or on guard? 1 2 3 4 5
17. Feeling jumpy or easily startled? 1 2 3 4 5
In the blank space before each question, put a number to
tell how much that thing has happened to you within the past two weeks. Use the scale below to decide which number to put
in the blank space. Put "0" if you never had the experience during the past two weeks and put a "10" if it was always happening
to you or happened to you everyday in the past two weeks. If it happens sometimes, but not everyday, put in one of the
numbers between "0" & "10" to tell how much it happened.
0 1 2 3 4 5 6 7 8 9 10
never happens always happens
___1. I don't feel like doing things I used to like doing.
___2. I can't remember much about bad things that have happened to me.
___3. I feel cut off & isolated from other people.
___4. I try not to think about things that remind me of something bad that happened to me.
___6. I have trouble concentrating on things or paying attention to something for a long time.
___7. I have a hard time thinking about the future & believing I'm going to live to an old age.
___8. I feel very irritable & lose my temper.
___9. I avoid doing things or being in situations that might remind me of something terrible that happened to me in the past.
___10. I am very aware of my surroundings & nervous about what's going on around me.
___11. I find myself remembering bad things that happened to me over & over, even when I don't
want to think about them.
___12. I get startled or surprised very easily & "jump" when I hear a sudden sound.
___13. I have bad dreams about terrible things that have happened to me.
___14. I get very upset when something reminds me of something bad that happened to me.
___15. I have trouble getting to sleep or staying asleep.
___16. When something reminds me of something bad that happened to me, I feel shaky, sweaty, nervous,
and my heart beats really fast.
___17. I suddenly feel like I am back in the past, in a bad situation that I was once in, and it's like
it was happening all over again.
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Please read all the statements
in each group. Circle the number beside the statement that best describes the way you've been feeling for the past two weeks.
If more than one statement is true, circle all the numbers of the statements that are true.
0 I don't feel sad.
1 I feel sad or blue.
2 I am blue or sad all the time & I can't snap out of it.
3 I am so sad or unhappy that I can't stand it.
0 My appetite is no worse than usual.
1 My appetite isn't as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.
0 I don't have any thoughts of harming myself.
1 I feel I would be better off dead.
2 I have definite plans about committing suicide.
3 I would kill myself if I had the chance.
0 I am not particularly pessimistic or discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless & that things can't improve.
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