# Evidence-based assessment/Posttraumatic stress disorder (disorder portfolio)/extended version

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Evidence-based assessment/Posttraumatic stress disorder (disorder portfolio)/Sidebar

## What is a "portfolio"?

* For background information on what assessment portfolios are, click the link in the heading above.
* Does this page feel like too much information? Click here for the condensed version.

## Preparation phase
### Diagnostic criteria for post traumatic stress disorder
#### ICD-11 Diagnostic Criteria
   #### ICD-11 Criteria

   * Post-traumatic stress disorder (PTSD) is a syndrome that develops following exposure to an extremely threatening or horrific event or series of events that is characterized by all of the following:
   ** 1) re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares, which are typically accompanied by strong and overwhelming emotions such as fear or horror and strong physical sensations, or feelings of being overwhelmed or immersed in the same intense emotions that were experienced during the traumatic event;
   ** 2) avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event or events
   ** 3) persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises.
   * The symptoms must persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
   Additionally, ICD 11 includes a category called "Complex post-traumatic stress disorder," which is described as:
   * A disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).
   * The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder.
   * In addition, Complex PTSD is characterized by:
   ** 1) severe and pervasive problems in affect regulation;
   ** 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event
   ** 3) persistent difficulties in sustaining relationships and in feeling close to others. The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

#### Changes in DSM-5

* The diagnostic criteria for post-traumatic stress disorder changed slightly from DSM-IV to DSM-5. Summaries are available here and here.

### Base rates of PTSD in different clinical settings and populations

This section describes the demographic settings of the populations sampled, base rates of PTSD diagnoses, country/region sampled, and the diagnostic methods that were used. Using this information, clinicians will be able to anchor the most appropriate rate of PTSD that they are likely to see in their clinical practice.
* To see prevalence rates across multiple disorders, click here.
| Setting | Base Rate | Demography | Diagnostic Method |
| Non-clinical: Population based | 6.8% | United States, nationally representative, age 18 and older | National Comorbidity Survey - Replication |
| Non-clinical: Population based | 7.4% | Netherlands, nationally representative, age 18-80 | Composite International Diagnostic Interview (CIDI) |
| Non-clinical: Population based | 6.4% | United States, nationally representative, age 18 and older | Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions |
| Non-clinical: Population based | 8.8% | Northern Ireland, representative sample, age 18 and older | Northern Ireland Study of Health and Stress |
| Non-clinical: Population based | 2.3% | South Africa, nationally representative sample, age 18 and older | South African Stress and Health Study, using the Composite International Diagnostic Interview (CIDI) |
| U.S. Service Members | 11.5% - 19.5% ♦ | U.S. Army and Marine Soldiers Deployed to Iraq and Afghanistan | PTSD Checklist |
| Non-clinical: Population based | 5.0% | United States, nationally representative, ages 13-18 | National Comorbidity Survey Replication—Adolescent Supplement (NCS-A) |
♦ Note: These rates were using broad PTSD Checklist scoring criteria of being scored positive if subjects reported at least one intrusion symptom, three avoidance symptoms, and two hyperarousal symptom that were categorized as at the moderate level. The 11.5% is for soldiers returning from deployment in Iraq, 19.5% is for soldiers returning from Afghanistan. Another common practice is to use a strict cutoff of 50 on the PCL, above which someone screens positive for PTSD. With this cutoff, rates are 6.2% and 12.9% for Service Members returned from Afghanistan and Iraqi, respectively.

## Prediction phase
### Psychometric properties of screening for PTSD

The following section contains a list of screening and diagnostic instruments for PTSD. The section includes administration information, psychometric data, and PDFs or links to the screenings.
* Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
* For a list of more broadly reaching screening instruments, click here.
| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Inter-rater reliability | Test-retest reliability | Construct validity | Content validity | Highly recommended |
| PCL (PTSD Checklist for DSM-5) | Self-Report | adult | 5-10 minutes | N/A | G | E | G | X |
| CAPS (Clinician Administered PTSD Scale) | Clinician Administered Interview | adult and child versions available | 40-60 minutes | E | E | E | E | X |
| SCID-IV (Structured Clinical Interview for DSM-IV) | Clinician Administered Interview | adult | 1-2 hours | A | A | G | G | X |
| PSS-I (PTSD Symptom Scale Interview) | Clinician Administered Interview | adult | 20 minutes | E | G | G | G | |
| SI-PTSD (Structured Interview for PTSD) | Clinician Administered Interview | adult | 20-30 minutes | E | A | G | G | |
| ADIS (Anxiety Disorder Interview Schedule) | Clinician Administered Interview | adult | 2-4 hours | G | A | G | G | |
| UCLA PTSD Reaction Index for DSM-5 | Clinician Administered | child, school age, adolescents | | G | | G | G | Yes |
| CPSS (Children's PTSD Symptom Scale) | Self-Report | child | 10-20 minutes | | | | | XX (new rec) |
| IES-R (Impact of Event Scale-Revised) | Self-Report | adult | 10-15 minutes | N/A | A | G | G | |
| M-PTSD (Mississippi Scale for Combat Related PTSD) | Self-Report | adult, specific versions for veterans and civilians | 10-15 minutes | N/A | G | E | E | |
| PK Scale (Keane PTSD Scale of the MMPI-2) | Self-report | adult | 60-90 minutes (entire MMPI-2) | N/A | G | E | G | |
| PDS (Post-traumatic Diagnosis Scale) | Self-Report | adult | 10-20 minutes | N/A | G | E | G | X |
| LASC (Los Angeles Symptoms Checklist) | Self-Report | adult | 5-10 minutes | N/A | G | G | G | |
| Child’s Reaction to Traumatic Events Scale-Revised | Self-Report | 7-16 | 5-10 Minutes | | | G | G | |
| Child Trauma Screening Questionnaire (CTSQ) | Self-Report | child | 5-10 minutes | | | G | G | |
| Children’s Revised Impact of Events Scale (CRIES-8) | Self-Report | 8+ (must be able to read) | 5-10 minutes | | | | | |
| Trauma Symptoms Checklist for Young Children (TSCYC) | Parent Report on Child | 3-12 years old | 15-20 minutes | For validities, norms vary based on gender and age group, since each has different scales. | | | | |
| Young Child PTSD Checklist (YCPC) | Parent Report | child | 13 items | G | | G | G | Yes |
| Child Behavior Checklist-Posttraumatic Stress Disorder Scale (CBCL-PTSD) | Parent Report | 6-18 years old | 10-15 minutes | | | G | | |
| International Trauma Questionnaire (ITQ) – Youth Version | Self-Report | child | 10 minutes | | | | | |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

### Likelihood ratios and AUCs of screening measures for PTSD

* For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
| Screening Measure (Primary Reference) | AUC (sample size) | DLR+ (score) | DLR- (score) | Clinical Generalizability | Download |

### Interpreting PTSD screening measure scores

* For information on interpreting screening measure scores, click here.
* Also see the page on likelihood ratios in diagnostic testing for more information

## Prescription phase
### Gold standard diagnostic interviews

* For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

### Recommended diagnostic interviews for PTSD

Diagnostic instruments for PTSD :
| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Interrater Reliability | Construct Validity |
| CAPS-5 (Clinician Administered PTSD Scale) | Clinician Administered Interview | adult | 40-60 minutes | | |
| PTSD Symptom Scale Interview (PSS-I-5) | Clinician Administered Interview | adult and child version available | 24 items | | |
| For Children and Adolescents Specifically | For Children and Adolescents Specifically | For Children and Adolescents Specifically | For Children and Adolescents Specifically | | |
| CAPS-CA-5 (Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version) | Clinician Administered Interview | child | 30 items | | |
| Children’s PTSD Inventory (CPTSD-I) | Diagnostic Interview | 6-18 years | 50 items | G | G |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

### Severity interviews for PTSD

| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Interrater Reliability | Construct Validity |
| Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS) | Diagnostic Interview | 6-18 years | 18 PTSD items | G | G |
| Anxiety Disorders Interview Schedule, Child Version (ADIS-C) | Diagnostic Interview | 7-17 years | 26 PTSD items | G | G |
| Children’s Interview for Psychiatric Symptoms (ChIPS) | Diagnostic Interview | 6 – 18 years | 31 PTSD items | G | G |
| Diagnostic Infant and Preschool Assessment (DIPA) | Diagnostic Interview | Age 6 and younger | 46 PTSD items | G | G |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

## Process phase

The following section contains a brief overview of treatment options for PTSD and list of process and outcome measures for PTSD. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

### Process measures

* Information coming soon

### Outcome and severity measures

This table includes clinically significant benchmarks for PTSD specific outcome measures
* Information on how to interpret this table can be found here.
* Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
* For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks with common instruments for PTSD :
| Benchmarks Based on Published Norms |||||||
| Measure | Cut-off scores | Cut-off scores | Cut-off scores | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) |
| Measure | A | B | C | 95% | 90% | SE$_{difference}$ |
| Primary Care PTSD Screen | 1.0 | 3.1 | 2.0 | 1.0 | .8 | .5 |
| PTSD Checklist Scores | 28.8 | 40.8 | 34.9 | 4.6 | 3.8 | 2.3 |
| Clinician Administered PTSD Scale | 28.8 | 40.8 | 34.9 | 8.3 | 7.0 | 4.2 |

### Treatment

* Please refer to the Wikipedia page on PTSD for more information on available treatment for PTSD or go to the Effective Child Therapy page for for a curated resource on effective treatments for PTSD.

## External resources
### For professionals

* Post Traumatic Stress Disorder Information Resource from The University of Queensland School of Medicine
* APA practice parameters for assessment and treatment for PTSD (Updated 2017)
* Resources for professionals from VA National PTSD Center
* SAMHSA's Trauma-Informed Care Resources and Training
* SAMHSA's Resources on Intimate Partner Violence (IPV) for Clinicians, Patients, Families, and Organizations

### For caregivers

* Tips for parents on shooting media coverage
* Parent guidelines to helping youths after a shooting
* Caregiver tips for helping teens with traumatic grief
* Caregiver tips for helping school-age children with traumatic grief
* EffectiveChildTherapy.Org information on PTSD
* Society of Clinical Child and Adolescent Psychology

### For educators

* Teacher tips for providing psychological first aid
* Educator tips for helping youths after a community trauma

### For public

* Resources for grief and loss
* Psychological impacts of recent shootings
* Tips to talking to youths about a shooting
* Tips to talking to children about a shooting
* Helping young children heal after a crisis
* Psychological first aid for schools
* Resources and manuals on psychological first aid
* Resources for the public from VA National PTSD Center
* Posttraumatic stress disorder at Curlie (based on DMOZ)