A comparison of persons with Posttraumatic stress disorder and the normative sample with the Trauma Symptom Inventory

IntroductionThe Trauma Symptom Inventory [1] (TSI) consists of 100 items and serves for the evaluation of acute and chronic trauma symptoms which include, but are not limited to, the consequences of rape, spousal abuse, physical assaults, serious accidents and natural disasters, permanent consequences of abuse in childhood as well as other early traumatic experiences. The TSI includes 10 clinical scales and 3 validity scales. The various scales of the TSI assess a wide range of psychological impacts, and five of the ten clinical scales measure symptoms closely related to the Diagnostic and Statistical Manual of Mental Disorders [2] (DSM-IV-TR) symptoms of posttraumatic stress disorder. Clinical scales include not only symptoms typically associated with Posttraumatic Stress Disorder (PTSD), but also those for the Acute Stress Disorder (ASD), and intra- and interpersonal difficul ties often associated with more chronic psychological trauma.In this research we wanted to evaluate the TSI, based on whether it is a good diagnostic instrument for diagnosing PTSD. The TSI does not generate DSM-V diagnoses; instead, it is intended to evaluate the relative level of various forms of posttraumatic distress. In 2014, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders. [2] Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/ numbing symptoms, and hyper-arousal symptoms. Fifth criterion concerns duration of symptoms and a sixth assesses functioning. It is estimated that the prevalence of PTSD in general population is between 1 and 7% (depending on the diagnostic criteria), while in Vietnam veterans, firemen, rape victims, and persons who have been exposed to extreme stressful situations, frequency of PTSD is somewhere in between 20 and 40%. [3-7]In validation studies done by Briere, [8] all of the clinical scales were higher in samples of PTSD group, compared to the normative non-PTSD sample. In the research done by McDevitt-Murphy, Weathers and Adkins, [9] PTSD and non-PTSD groups differed on seven TSI clinical scales and one validity scale, with Cohen's d ranging from 0.26 to 0.53. In that research, the largest effect sizes and best diagnostic utility were found on two clinical scales: Defensive Avoidance and Anxious Arousal scale. We wanted to further investigate, whether the same scales are equally important in Croatian PTSD sample. It is confirmed that there is a substantial evidence of the cross-cultural validity of PTSD. [10] However, evidence of cross-cultural variability in certain areas suggests the need for further research. Also we were interested whether the symptoms stated in the DSM-V for PTSD is also valid and do they have similar frequency in Croatian.The aim of this study was to examine whether the scales are related to PTSD symptoms, and which scales would best predict the diagnosis of PTSD.Subjects and MethodsSubjectsIn this research we gathered the data for 235 participants, of which all of them were males (average age: 33 years) from the community. All of the participants gave their written consent for the participation in this research.The clinical sample consisted of 51 males, between 38 and 61 years of age (average age: 48.5 years). The participants were hospitalized based on a diagnosis of PTSD. All of those patients developed PTSD during the war, as they were Croatian soldiers in the Croatian War of Independence (1991 - 1995).All of the participants completed the Croatian version of TSI. [1]MeasurementThe TSI has a total of 100 items and contains 10 clinical scales. In the manual1 for the TSI are stated the reliabilities for the scales: Anxious Arousal (AA; 8 items, alpha = 0,81), Depression (D; 8 items, alpha = 0,79), Anger/Irritability (AI; 9 items, alpha = 0,87), Intrusive Experiences (IE; 8 items, alpha = 0,84), Defensive Avoidance (DA; 8 items, alpha = 0,87), Dissociation (DIS; 9 items, alpha = 0,78), Sexual Concerns (SC; 9 items, alpha = 0,78), Dysfunctional Sexual Behavior (DSB; 9 items, alpha = 0,81), Impaired Self- Reference (ISR; 9 items, alpha = 0,84), and Tension Reduction Behavior (TRB; 8 items, alpha = 0,54). …