Assessing the severity of posttraumatic stress disorder: Relation between dichotomous and continuous measures.

Both the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) and the Impact of Event Scale (IES) assess distress following trauma. This article assesses the interrelation between these two instruments for soldiers who suffered from combat stress reactions (N?=?382) and for a matched group (N?=?334). Results indicated that subjects suffering from posttraumatic stress disorder (PTSD) according to the DSM-III yielded higher scores of the Intrusion and Avoidance factors of the IES. Furthermore, the Intrusion factor was predominantly associated with each of the criteria of the DSM-III diagnosis. Although the IES and the DSM-III overlap, they may tap different aspects of battle-related PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale.

The present article reports on the development and validation of a self-report measure of posttraumatic stress disorder (PTSD), the Posttraumatic Diagnostic Scale (PTDS), that yields both a PTSD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994 DSM-IV) criteria and a measure of PTSD symptom severity. Two-hundred forty-eight participants who had experienced a wide variety of traumas (e.g., accident, fire, natural disaster, assault, combat) were administered the PTSD module of the Structured Clinical Interview (SCID; Spitzer, Williams, Gibbons, & First, 1990), the PTDS, and scales measuring trauma-related psychopathology. The PTDS demonstrated high internal consistency and test-retest reliability, high diagnostic agreement with SCID, and good sensitivity and specificity. The satisfactory validity of the PTDS was further supported by its high correlations with other measures of trauma-related psychopathology. Therefore, the PTDS appears to be a useful tool for screening and assessing current PTSD in clinical and research settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analysis of the clinician-administered PTSD Scale: Evidence for the dimensionality of posttraumatic stress disorder.

The Clinician-Administered PTSD Scale (CAPS; Blake et al., 1990) is a structured interview that assesses the 17 key symptoms of posttraumatic stress disorder ( PTSD) as established in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994). CAPS data from 524 treatment-seeking male military veterans were submitted to confirmatory factor analysis to test a series of nested models reflecting alternative representations of PTSD dimensionality: (a) a 4-factor, 1st-order solution; (b) a 2-factor, higher order solution; (c) a single-factor, higher order solution; and (d) a single-factor, 1st-order solution. The model of best fit was the 4-factor, 1st-order solution, containing moderately to highly correlated yet distinct 1st-order factors corresponding to the reexperiencing, effortful avoidance, emotional numbing, and hyperarousal aspects of PTSD. Implications for theory, assessment, and future research are presented in this article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric qualities of the German version of the Posttraumatic Diagnostic Scale (PTDS).

In the present study, the psychometric properties of the German version of the Posttraumatic Diagnostic Scale (PTDS; A. Ehlers, R. Steil, H. Winter, & E. B. Foa, 1996) were evaluated in a sample of 143 trauma survivors. To investigate convergent and discriminant validity of this questionnaire, the authors assessed posttraumatic stress disorder (PTSD), anxiety, depression symptoms, and social phobia. Internal consistencies of the PTDS and its subscales as well as their association with related measures show that the German PTDS is a reliable and valid instrument for the assessment of posttraumatic stress symptoms. A 3-factor structure was found that is, however, not exactly in concordance with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) formulation (Reexperiencing, Avoidance, and Hyperarousal) but rather comprises a Reexperiencing/Avoidance factor; an Emotional Numbing/Hyperarousal factor; and a 3rd factor, consisting of Hypervigilance and an Exaggerated Startle Response. The findings are discussed with respect to their equivalency to the original PTDS, core symptoms of PTSD, and desirable future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale.

The use of structured interviews that yield continuous measures of symptom severity has become increasingly widespread in the assessment of posttraumatic stress disorder (PTSD). To date, however, few scoring rules have been developed for converting continuous severity scores into dichotomous PTSD diagnoses. In this article, we describe and evaluate 9 such rules for the Clinician-Administered PTSD Scale (CAPS). Overall, these rules demonstrated good to excellent reliability and good correspondence with a PTSD diagnosis based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III—R; American Psychiatric Association, 1987). However, the rules yielded widely varying prevalence estimates in 2 samples of male Vietnam veterans. Also, the use of DSM-III—R versus DSM-IV criteria had negligible impact on PTSD diagnostic status. The selection of CAPS scoring rules for different assessment tasks is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer.

Diagnosis of life-threatening illness now meets Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for traumatic stressor exposure for posttraumatic stress disorder (PTSD). Quality of life (QOL) and PTSD-like symptoms were assessed in 55 women posttreatment for breast cancer. PTSD symptom measures included the PTSD Checklist—Civilian Version (PCL-C) and the Impact of Events Scale. QOL was assessed using the 20-item Medical Outcomes Study Questionnaire. PTSD symptomatology was negatively related to QOL, income, and age. Time since treatment, type of cytotoxic treatment, and stage of disease were unrelated to PTSD symptoms. With suggested criteria for the PCL-C, 5% to 10% of the sample would likely meet DSM-IV PTSD criteria. Findings suggest that in survivors of breast cancer, these symptoms might be fairly common, may exceed the base rate of these symptoms in the general population, are associated with reports of poorer QOL, and, therefore, warrant further research and clinical attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Construct Validity of the Posttraumatic Stress Disorder Checklist in Cancer Survivors: Analyses Based on Two Samples.

The measurement of posttraumatic stress disorder (PTSD) is critically important for the identification and treatment of this disorder. The PTSD Checklist (PCL; F. W. Weathers & J. Ford, 1996) is a self-report measure that is increasingly used. In this study, the authors investigated the factorial validity of the PCL with data from 236 cancer survivors who received a bone marrow or stem cell transplantation. The authors examined the fit of these data with the clinical model of 3 symptom clusters for PTSD, as proposed in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), and alternative models tested in prior research. By using confirmatory factor analysis the authors found that a 4-first-order-factor model of PTSD provided the best fit. The relations of PTSD symptoms with sociodemographic and medical variables were also explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute stress disorder scale: A self-report measure of acute stress disorder.

The Acute Stress Disorder Scale (ASDS) is a self-report inventory that (a) indexes acute stress disorder (ASD) and (b) predicts posttraumatic stress disorder (PTSD). The ASDS is a 19-item, inventory that is based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) criteria. The ASDS possessed good sensitivity (95%) and specificity (83%) for identifying ASD against the ASD Interview on 99 civilian trauma survivors. Test-retest reliability of the ASDS scores between 2 and 7 days was strong (r? =? .94). The ASDS predicted 91% of bushfire survivors who developed PTSD and 93% of those who did not; one third of those identified by the ASDS as being at risk did not develop PTSD, however. The ASDS shows promise as a screening instrument to identify acutely traumatized individuals who warrant more thorough assessment for risk of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The validity of the DSM-III posttraumatic stress disorder classification as applied to adolescents.

Examined the validity of the posttraumatic stress disorder (PTSD) classification as it applies to adolescents of both sexes. 24 adolescents (mean age 13.81 yrs) who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for Axis 1 PTSD, 24 Ss (mean age 13.67 yrs) who met DSM-III criteria for simple phobia, and 24 controls (mean age 13.28 yrs) were compared using a children's PTSD inventory, a children's manifest anxiety scale, the Children's Depression Inventory, and the Test Anxiety Inventory. Their work was also rated by their classroom teachers according to the Connors Teacher Rating Scale criteria. The PTSD group was found to evidence higher levels of self-reported anxiety, depression, and behavior problems than other groups. The simple phobia group presented higher levels of self-reported test anxiety than other groups. Findings support the DSM-III PTSD classification as it applies to adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: Three studies in reliability and validity.

The Mississippi Scale for Combat-Related Posttraumatic Stress Disorder is a 35-item self-report scale derived from Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for the disorder. This article describes a series of three studies designed to explore the psychometric properties of the scale. Study 1 used 362 Vietnam veterans seeking help at Vet Centers (Operation Outreach) to confirm the internal consistency of the instrument and provide an assessment of its factor structure. Study 2 demonstrated the high test–retest reliability of the instrument over a period of 1 week. Study 3 indicated that the test's sensitivity was .93, specificity was .89, and overall hit rate was .90 when it was used to differentiate between a posttraumatic stress disorder (PTSD) group and two non-PTSD comparison groups. The utility of the test when it is administered within the context of a multiaxial approach to assess military-related PTSD is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of a brief measure of posttraumatic stress disorder: The Distressing Event Questionnaire (DEQ).

The Distressing Event Questionnaire (DEQ) is a brief instrument for assessing posttraumatic stress disorder (PTSD) according to criteria provided in Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The DEQ possesses high internal consistency and exhibited satisfactory short-term temporal stability in studies with Vietnam War combat veterans and battered women. In a sample of Vietnam War veterans and 4 separate samples of abused women (with histories of incest, rape, intimate partner abuse, or prostitution and abuse), the DEQ exhibited very good discriminative validity when judged against structured interview assessment of PTSD. The DEQ exhibited strong convergent validity with other PTSD measures and other indexes of adjustment and also exhibited strong convergent validity as a measure of PTSD across ethnic groups in both the veteran sample and the combined women's sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective examination of delayed onset PTSD secondary to motor vehicle accidents.

Seven participants who did not meet the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for posttraumatic stress disorder (PTSD) 1-4 months post-motor vehicle accident (MVA) and developed delayed onset PTSD during a 1-year follow-up interval were compared with 38 MVA controls who did not develop PTSD, as well as to 62 MVA participants who met criteria for acute onset PTSD on variables related to demographics, pre-MVA functioning, post-MVA functioning, and follow-up. The delayed onset participants were more symptomatic at the time of the initial interview than the controls. The delayed onset participants had poorer social support than the controls prior to and after the MVA. For the month prior to the MVA, the delayed onset participants had lower Global Assessment of Functioning scores than the controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled study of treatment of PTSD using EMDR in an HMO setting.

67 individuals (aged 18–73 yrs) diagnosed with posttraumatic stress disorder (PTSD) were randomly assigned to either Eye Movement Desensitization and Reprocessing (EMDR) treatment or Standard Care (SC) treatment. Participants were assessed pretreatment, after 3 sessions, and at the completion of treatment using the SCL-90, Beck Depression Inventory, Impact of Event Scale (M. Horowitz et al, 1979), modified PTSD Symptom Scale (S. A. Falsetti et al, 1993), State Trait Anxiety Inventory, and other measures. In addition, an independent evaluator assessed participants using Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for PTSD including Global Assessment of Functioning at the 3 data points. Ss in the EMDR treatment group showed significantly greater improvement with greater rapidity than those in the SC treatment group on measures of PTSD, depression, anxiety, and general symptoms. Ss who received EMDR treatment used fewer medication appointments for their psychological symptoms and needed fewer psychotherapy appointments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic self-destructiveness and self-defeating personality: similarities and differences

This study attempts to determine whether the Chronic Self-Destructiveness Scale (CSDS; Kelley, Byrne, et al., 1985) would be better described as a measure of impulsiveness or self-defeating behavior in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., Rev. [DSM-III-R]; American Psychiatric Association, 1987) diagnostic sense. Subjects completed the CSDS, the Self-Defeating Scale (Schill, 1990), and measures of restraint, distress, and psychopathy. Based on the correlations among these scales, we suggest that the CSDS is better described as a measure of impulsiveness, poor judgment, and immediate gratification, rather than a measure of Self-Defeating Personality, which keeps the individual in a victim position.     

De novo conditioning in trauma-exposed individuals with and without posttraumatic stress disorder.

Differential conditioning was assessed in 15 medication-free individuals meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for chronic posttraumatic stress disorder (PTSD) and 18 trauma-exposed individuals who never developed PTSD (non-PTSD). Conditioned stimuli (CSs) were colored circles, and the unconditioned stimulus was a "highly annoying" electrical stimulus. Individuals with PTSD had higher resting heart rate (HR) and skin conductance (SC) levels and produced larger SC orienting responses. During conditioning, the PTSD group showed larger differential SC, HR, and electromyogrant responses to the reinforced vs. nonreinforced stimuli (CS+ vs. CS-) compared with the non-PTSD group. Only PTSD participants continued to show differential SC responses to CS+ vs. CS- during extinction trials. Results suggest that individuals with PTSD have higher sympathetic nervous system arousal at the time of conditioning and are more conditionable than trauma-exposed individuals without PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and childhood abuse in battered women: Comparisons with maritally distressed women.

In the present study, posttraumatic stress disorder (PTSD) prevalence rates were compared among 50 battered women and 37 maritally distressed women who had not experienced battering (N?=?87). Participants were administered R. Spitzer and I. B. S. Williams's (1985) Structured Clinical Interview for the DSM-III—R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) to assess PTSD status and previous traumatic experiences in addition to other standardized measures of PTSD and violence exposure. Battered women exhibited significantly higher rates of PTSD than maritally distressed women (58% vs. 18.9%). Although both groups had similar rates of previous trauma experiences, women with a PTSD-positive status (both battered women and maritally distressed women) were significantly more likely to have experienced self-reported childhood sexual abuse and a higher overall number of previous traumas than those with a PTSD-negative status. Battering exposure and childhood sexual abuse predicted 37% of the variance in overall PTSD intensity levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for principal versus comorbid conditions in psychiatric outpatients with the Psychiatric Diagnostic Screening Questionnaire.

In examining the performance of screening scales, a distinction should be made between principal and additional diagnoses. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong self-report scale designed to screen for the most common Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders encountered in outpatient mental health settings. In the present report, the authors compared the performance of the PDSQ in identifying principal and comorbid disorders. Seven hundred ninety-nine psychiatric outpatients completed the PDSQ and were interviewed with the Structured Clinical Interview for DSM-IV. The sensitivity and negative predictive values of the PDSQ subscales were similar for principal and additional diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiology of Trauma and Posttraumatic Stress Disorder in Mexico.

Prevalence rates of trauma and posttraumatic stress disorder (PTSD) were estimated from a probability sample of 2,509 adults from 4 cities in Mexico. PTSD was assessed according to Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) criteria using the Composite International Diagnostic Interview (CIDI; WHO, 1997). Lifetime prevalence of exposure and PTSD were 76% and 11.2%, respectively. Risk for PTSD was highest in Oaxaca (the poorest city), persons of lower socioeconomic status, and women. Conditional risk for PTSD was highest following sexual violence, but nonsexual violence and traumatic bereavement had greater overall impact because of their frequency. Of lifetime cases, 62% became chronic; only 42% received medical or professional care. The research demonstrates the importance of expanding the epidemiologic research base on trauma to include developing countries around the world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a Psychometrically Sound Internet Addiction Scale: A Preliminary Step.

The Internet Addiction Scale (IAS) is a self-report instrument based on the 7 Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) substance dependence criteria and 2 additional criteria recommended by Griffiths (1998). The IAS was administered to 233 undergraduates along with 4 measures pertaining to loneliness and boredom proneness. An item reliability analysis reduced the initial scale from 36 to 31 items (with a Cronbach's alpha of .95). A principal-components analysis indicated that the IAS consisted mainly of one factor. Multiple regression analyses revealed that Family and Social Loneliness and Boredom Proneness were significantly correlated with the IAS; Family and Social Loneliness uniquely predicted IAS scores. No evidence for widespread Internet addiction was found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)