CNL523_T5_Psychological Testing and Clinical Diagnosis
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Testing and Diagnosis of Posttraumatic Stress Disorder (PTSD)
College of Humanities and Social Sciences, Grand Canyon University
CNL-523: Assessments Tests and Measurements
June 21
st
, 2023
Testing and Diagnosis of Posttraumatic Stress Disorder (PTSD)
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There is a misconception about posttraumatic stress disorder, or PTSD, that it is something that only affects soldiers returning from war, and that it involves flashbacks of experiences from battle. Now, PTSD most certainly can
be a mental health consequence of engaging in war, and flashbacks are
a potential symptom. However, PTSD is much more complex than that, and impacts a much larger scale of people. The following will provide a summary of PTSD, as well as a discussion on diagnostic tools that can be utilized to assess for the disorder, and explanation of the reliability and validity of those tests.
What is PTSD?
According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5 TR), PTSD can occur when an individual experiences exposure to death, threatened death, serious injury, or sexual violence (American Psychiatric Association [APA], 2022). There are a multitude of potential adverse symptoms with a wide spectrum of severity levels. One category of PTSD features are intrusion symptoms
, which may manifest as recurrent, involuntary memories of the event or dissociative reactions such as flashbacks, where the individual feels as though the event is recurring (APA, 2022). Another category of PTSD features is avoidance symptoms, which manifest as the individual’s avoidance of stimuli that could potentially trigger memories or flashbacks (APA, 2022). This may be people, places, or conversations about the traumatic experience. The fourth category is identified by negative
changes in cognition or mood
following the traumatic event. These symptoms can manifest as dissociative amnesia, exaggerated negative beliefs about oneself, or even blaming the trauma on themselves (APA, 2022). The final category of symptoms that an individual who has a PTSD diagnosis will demonstrate is arousal and 3
reactivity. These symptoms may be evident by angry outbursts, reckless behavior, hypervigilance, or exaggerated startle response (APA, 2022). An individual who has been diagnosed with PTSD will demonstrate at least one of the first 3 categories and two of the 4
th
and 5
th
, for a duration of more than a month; and the symptoms cannot be the result of psychoactive substance use. Additionally, the individual will be experiencing a disturbance in functioning socially, occupationally, or in other important areas (APA, 2022). Diagnostic Tools
Because PTSD is a complex disorder and clients who are presenting with these symptoms
are often desperate for help, it is imperative that clinicians utilize proper assessment tools. For instance, a personality assessment
would not be appropriate when evaluating an individual for PTSD, as this type of assessment analyzes traits, values, interests, attitudes, worldview, etc., related to individual characteristics (Cohen, et al., 2022). Personality assessment determines who the person is, whereas trauma is something that happens to a person, or what they have been through, and is not intrinsic to who they are.
Mental health professionals must do their due diligence to provide a comprehensive psychological assessment
by emphasizing symptoms that are important across diagnoses. The DSM-5 Cross-Cutting Symptom Measures help identify how varying combinations of cross-
cutting symptoms at different severity levels may be present across diagnoses, which can ultimately impact client outcomes (Clarke & Kuhl, 2014). There are diagnostic tools for mental health professionals to use in tandem with the DSM-5 to ensure proper, well-informed diagnosis. The Posttraumatic Stress Diagnostic Scale (PDS), for example, is a 49-item clinical screening instrument designed to assess the presence 4
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and severity of PTSD, as well as monitor treatment progress (Axford, 2001). The Traumatic Life Events Questionnaire (TLEQ) is another helpful diagnostic instrument that consists of 22 items inquiring about specific events such as car accidents, war, sudden death of a loved one, domestic violence, or other events that would be categorized as traumatic, as well as assessment of frequency and severity of emotional response (Donnelly & Sheperis, 2007).
Validity and Reliability
When choosing a diagnostic tool, the mental health professional must be assured that the instrument is valid
, or appropriate for the intended criteria, and the results can be used for diagnosis and reliable
, which means it has provided consistent results over multiple tests over time (Cohen, et al., 2022). The PDS originally was developed to correspond with the DSM-IV, but it was updated in 2013 to reflect DSM-5 diagnostic criteria. In the development of the PDS, a
normative sample was gathered from Veterans Administration hospitals, clinics that treat PTSD and anxiety, women's shelters, emergency rooms, fire and ambulance stations, as well as inpatient rehabilitation facilities (Axford, 2001). This shows that the test would be appropriate for someone who is suspected of having PTSD, since the norming sample was comprised of individuals who had experienced a traumatic event. Additionally, 110 retests were administered, with intervals of approximately 16 days, with 87.3% diagnostic agreement (Axford, 2001). These
results support internal consistency and ultimately the reliability of the PDS. Like the PDS, the TLEQ used a norming sample during the development that supported validity for testing for PTSD. The sample population was comprised of Vietnam vets, inpatient treatment patients, college students, and a support group for women survivors of domestic abuse (Donnelly, & Sheperis, 2007). The TLEQ was also tested for consistency. Because the TLEQ is 5
not a scale that produces scores, the analysis was focused on time-related consistency of reports of trauma in four samples over fluctuating intervals from 5 to 60 days (Donnelly, & Sheperis, 2007).
Conclusion
PTSD is a serious and complex disorder, and diagnosis must be done thoroughly and effectively to ensure proper treatment. While many soldiers who experience war do in fact develop PTSD, the disorder impacts a wide variety of people who have experienced a traumatic event. And since trauma is subjective to a point, it is important that mental health utilize proper assessment tools for diagnosis, by assuring the instrument is valid, reliable, and compatible with the latest version of the DSM. 6
References
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Axford, S. N., & Doll, B. J. (2001). Posttraumatic Stress Diagnostic Scale. The Fourteenth Mental Measurements Yearbook
.
Clarke, D., Kuhl, E. (2014). DSM-5 cross-cutting symptom measures: a step towards the future of psychiatric care? World Psychiatry
. doi: 10.1002/wps.20154. PMID: 25273306; PMCID: PMC4219074. Cohen, R. J., Schneider, W. J., & Tobin, R. M. (2022). Psychological testing and assessment: An introduction to tests and measurement
(10th ed.). McGraw-Hill Companies. ISBN-13: 9781260837025
Donnelly, J. P., & Sheperis, C. J. (2007). Trauma Assessment Inventories. The Seventeenth Mental Measurements Yearbook
.
LeBeau, R., Mischel, E., Resnick, H., Kilpatrick, D., Friedman, M., Craske, M. (2014). Dimensional assessment of posttraumatic stress disorder in DSM-5. Psychiatry Research
.
Volume 218, Issues 1–2, 2014, Pages 143-147, ISSN 0165-1781 https://doi.org/10.1016/j.psychres.2014.03.032.
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