Social Work Question – Understanding Diagnosis Assessment and Approaches

Summary of PTSD

Symptoms

After exposure to an experience that is traumatic, people might have post-traumatic stress disorder (PTSD), a condition of psychological health causing intense suffering and interferes with daily life. Based on the DSM-IV-TR (DSM), symptoms of PTSD have been categorized into four groups including; intrusion, avoiding certain ideas and actions, negative shifts in attitude and thought, and reactivity and arousal changes (APA, 2020). Most traumatic experiences are pointed out by these symptoms. A group of linked symptoms is present in each of the categories. When it comes to intrusion people with PTSD tend to experience intrusive memories and thoughts linked to traumatic events. For avoidance, individuals experiencing PTSD are likely to avoid situations, places, discussions, events, objects, or individuals who may trigger the traumatic incidents (Dutra & Sadeh, 2018). Besides, they tend to avoid feelings, sentiments, or sensations related to the incidents. In the category of negative shifts in ideas, people who have PTSD may feel unfavorably affected all the time (for instance, anger, shame, or fear). For arousal and reactivity changes, people who have PTSD frequently feel like they must be continually “on guard” or that there is always danger everywhere.

Prevalence

6% of people, or roughly 6 individuals in 100, will experience PTSD at a certain point in their life (Mavranezouli et al., 2020). Approximately 12 million adults in the US have PTSD annually. According to national estimates of the prevalence of PTSD, DSM-5 rates were only marginally (usually approximately 1%) lower than DSM-IV rates for both lifetime and the previous 12 months. 5.6% of cases of PTSD with delayed start (diagnosis made over 6 months after a traumatic experience) occur. Most of the people with a delayed onset were veterans and other professionals who had previously experienced subclinical symptoms.

Development

PTSD majorly develops from stressful, frightful negative incidents resulting from traumatic experiences. For instance, the occurrence of PTSD can be triggered by serious accidents and physical or sexual assault (Mavranezouli et al., 2020). Biologically, the body tends to release stress hormones causing the symptoms of PTSD. Experts indicate that individuals having PTSD symptoms tend to have increased activity in the amygdala, the part of the brain regulating emotions and fear. Over time, PTSD is likely to change the brain. The hippocampus, which governs memory, may be reduced.

Course

To qualify as post-traumatic stress disorder (PTSD), symptoms should have lasted for over one month and be very severe that it affects people’s daily functioning including their work and relationships (Dutra & Sadeh, 2018). The symptoms of PTSD are likely to develop differently from one person to another. While some individuals experience symptoms enduring for only six months, other people are likely to have symptoms lasting longer. Some individuals develop a chronic ailment.

Types of Tools used to Make Diagnosis

The DSM’s Cross-Cutting Symptom Measure

This is an effective screening tool that can be used to measure symptoms relevant to PTSD. In particular, the DSM-5 level 1 measure consists of 23 symptoms that are self-rated including 13 related to mental health issues. Utilizing a five-point response scale, respondents express how much (or how frequently) each symptom has troubled them over the previous two (USDVA, 2023). Except for drug use, a score of 2 or higher in the majority of areas is indicative of clinically applicable mental health issues.

Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

CAPS-5 is one of the most effective tools developed by the National Center for PTSD to make a diagnosis of PTSD. The tool consists of 30 items for a structured interview. It is often employed to find out, evaluate and make a diagnosis for over one-week symptoms of PTSD (USDVA, 2023). Typically, the interview is often conducted for about half an hour or less and was created to be used by clinical researchers and clinicians who have critical knowledge about PTSD.

Structured Clinical Interview; PTSD Module (SCID PTSD Module)

This is a semi-structured interview commonly known as the SCID-5 and is often used to make the key DSM-5 diagnoses. A qualified mental health professional must administer the instrument for it to be effective in measuring PTSD symptoms (Mavranezouli et al., 2020). All diagnostic symptoms in the SCID are classified as present, subthreshold, or absent; there is no quantitative scoring system in place.

Recommended Psychological Tests

The Davidson Trauma Scale (DTS)

People can use the Davidson Trauma Scale (DTS), a self-evaluation tool, to check for PTSD. It often employs a four-item scale known as SPAN used to examine startle, physiological arousal, rage, and emotional numbness—the four main PTSD-related factors (APA, 2020). This 17-item exam asks the participant to rank the seriousness of each symptom according to its SPAN category. It takes approximately 10 minutes to complete the test and it costs about 15 U.S dollars. According to the Mental Measurements Yearbook, DTS is both valid and reliable. Its scale has a very strong internal consistency and reliability of test-retest, and a validity construct (usually defined as having 3 or 4 elements) and validity convergent (having other assessments of PTSD).

PTSD Symptom Scale Interview (PSS-I and PSS-I-5)

Another effective tool is the PSSI. With 17 items for evaluation measure, the PSS-I has questions for patients including naming a particular experience that is traumatic and led to their PTSD symptoms (Mavranezouli et al., 2020). The symptoms of over two weeks are often noted and assessed in connection to DSM-5’s analysis measures. In the PSS-I-5, there are approximately 24 items that show the symptoms of a diagnosis. Four of the items ask about symptoms such as onset, interference, distress, and duration. The Mental Measurements Yearbook indicates that PSS-1 is a valid and reliable test for survivors of trauma. The interview takes about 45 minutes to half an hour. There is no cost to conducting a PSS-1.

Treatment-Outcome Post Traumatic Stress Disorder Scale (TOP-8)

The TOP-8, is an effective interview-grounded evaluation instrument, to comprehend and rank symptoms. The scale consists of eight items that are taken from the main PTSD symptom categories, such as intrusion, avoidance, and numbing (APA, 2020). According to the Mental Measurements Yearbook, TOP-8 is valid and reliable and has a diagnostic accuracy of approximately 95% for measuring PTSD symptoms. It takes about 30 minutes to administer TOP-8 at no cost.

Why a personality assessment would be an appropriate tool for PTSD

I think that personality assessment tools would be appropriate for PTSD. It is ideal to administer personality tests as part of a comprehensive psychological evaluation. Cognitive, intellectual, and social functioning cannot be accurately measured in isolation from personality functioning (Dutra & Sadeh, 2018). Each domain informs the others and helps the individual as a whole to function. According to research, PTSD can be identified by using over-reporting scores on personality tests like the Personality Assessment Inventory and the MMPI-2, Revised Form.

References

American Psychiatric Association (APA). (2020). Assessment measures. In Diagnostic and statistical manual of mental disorders. Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasures

Dutra, S. J., & Sadeh, N. (2018). Psychological flexibility mitigates the effects of PTSD symptoms and negative urgency on aggressive behavior in trauma-exposed veterans. Personality Disorders: Theory, Research, and Treatment, 9(4), 315. https://doi.org/10.1037/per0000251

Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., … & Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: A network meta-analysis. Psychological Medicine, 50(4), 542-555.

US Department of Veteran Affairs (USDVA). (2023). “PTSD: National Center for PTSD.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp#:~:text=The%20PCL%2D5%20is%20a,Screening%20individuals%20for%20PTSD