How can one tell if distress after a personal tragedy is a
normal reaction to an upsetting life experience or something more
serious?
It can be difficult to know whether distress is a normal
reaction or a symptom of something more serious. Even
experts may require the results of a detailed evaluation to
answer this question. Posttraumatic Stress Disorder (PTSD)
is only one of many possible reactions to a traumatic
experience. After a trauma, some people become anxious,
some become depressed, and many find that they are not able to
deal with their responsibilities as well as they had before the
trauma. Although the majority of people are
distressed for a while, over a period of a few weeks to a few
months, most find that their upset lessens and they are better
able to function. Someone who continues to be profoundly
affected by their experience several months or even years later
may be struggling with PTSD.
What is PTSD?
The main features of PTSD can be summarized as follows:
Trauma
PTSD is different from most mental-health diagnoses because it
is tied to a to particular life experience. A traumatic
experience typically involves the potential for death or serious
injury resulting in intense fear, helplessness, or horror.
Symptoms
PTSD is characterized by a specific group of symptoms that
sets it apart from other types of reactions to trauma.
Increasingly, evidence points to four major types of symptoms:
re-experiencing, avoidance, numbing, and arousal.
Re-experiencing symptoms
These sypmptoms involve a sort of mental replay
of the trauma, often accompanied by strong emotional
reactions. This can happen in reaction to thoughts or
reminders of the experience when the person is awake or in the
form of nightmares during sleep.
Avoidance symptoms
Are often exhibited as efforts to evade
activities, places, or people that are reminders of the
trauma.
Numbing symptoms
These are typically experienced as a loss of
emotions, particularly positive feelings.
Arousal symptoms
Arousal symptoms reflect excessive physiological
activation and include a heightened sense of being on guard as
well as difficulty with sleep and concentration.
Length and Severity
To qualify for a formal diagnosis, the symptoms must persist
for over one month, cause significant distress, and affect the
individual's ability to function socially, occupationally, or
domestically.
How do I get an evaluation?
While it may be tempting to identify PTSD for yourself or
someone you know, the diagnosis generally is made by a
mental-health professional. This will usually involve a
formal evaluation by a psychiatrist, psychologist, or clinical
social worker who is specifically trained to assess psychological
problems.
What can I expect from an evaluation for PTSD?
The nature of an evaluation for PTSD can vary widely depending
on how the evaluation will be used and the training of the
professional evaluator. An interviewer may take as little
as 15 minutes to get a sense of your traumatic experience and the
effect it has had on your life in order to determine whether
treatment for PTSD is called for. On the other hand, a
specialized PTSD assessment can take eight or more 1-hour
sessions when the information is needed for legal or disability
claims. Regardless of the length of the evaluation, you can
expect to be questioned in depth about experiences that may have
been traumatic for you and about symptoms you may be experiencing
as a result of these experiences. Evaluations that are more
thorough are likely to involve detailed, structured interviews
and psychological tests on which you record your thoughts and
feeling. Your spouse or partner may be asked to provide
additional information, and you may undergo a procedure that
examines your physiological reactions to mild reminders of your
trauma. Whatever the particulars of your situation, you
should always be able to find out in advance from the
professional conducting the evaluation what the assessment will
involve and what information it is expected to provide.
What are some of the common assessments for PTSD?
As noted above, two main categories of PTSD evaluations are
structured interviews and self-report questionnaires. The
Clinician Administered PTSD Scale (CAPS) was developed by
National Center for PTSD staff and is among the most widely used
types of interviews. It has a format that requests
information about the frequency and intensity of the core PTSD
symptoms and of some common associated symptoms, which may have
important implications for treatment and recovery. Another
widely used interview is the Structured Clinical Interview for
DSM (SCID). The SCID can be used to assess a range of
psychiatric disorders including PTSD. Other interview
instruments include the Anxiety Disorders Interview
Schedule-Revised (ADIS), the PTSD-Interview, the Structured
Interview for PTSD (SI-PTSD), and the PTSD Symptom Scale
Interview (PSS-I). Each has unique features that might make
it a good choice for a particular evaluation.
Several self-report measures have also been developed as time-
and cost-efficient vehicles for obtaining information about
PTSD-related distress. These measures provide a single
score representing the amount of distress an individual is
experiencing. Among this set is another widely used measure
developed by National Center for PTSD staff, the PTSD Checklist
(PCL). This measure comes in two versions, one
oriented for civilians and another specifically designed for
military personnel and veterans. Other widely used
self-report measures are the Impact of Event Scale-Revised
(IES-R), the Keane PTSD Scale of the MMPI-2, the Mississippi
Scale for Combat Related PTSD and the Mississippi Scale for
Civilians, the Posttraumatic Diagnostic Scale (PDS), the Penn
Inventory for Posttraumatic Stress, and the Los Angeles Symptom
Checklist (LASC).
