The revised Clinician-Administered PTSD scale for DSM-5 (CAPS-5-R): Initial psychometric evaluation in a trauma-exposed community sample.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a widely used, well-validated structured interview for posttraumatic stress disorder (PTSD). It was recently revised to improve various aspects of administration and scoring. We conducted a psychometric evaluation of the revised version, known as the CAPS-5-R. Participants were 73 community residents with mixed trauma exposure (e.g., sexual assault, physical assault, transportation accident, the unnatural death of a loved one). CAPS-5-R PTSD diagnosis demonstrated good test-retest reliability, кs = .73-.79; excellent interrater reliability, кs = .86-.93; and good-to-excellent alternate forms reliability with the CAPS-5, кs = .79-.93. In addition, the CAPS-5-R total PTSD severity score demonstrated excellent test-retest reliability, intraclass correlation coefficient (ICC) = .86; interrater reliability, ICC = .98; and alternate forms reliability with the CAPS-5, r = .95. Further, the CAPS-5-R demonstrated good convergent validity with other measures of PTSD and good discriminant validity with measures of other constructs (e.g., depression, anxiety, alcohol problems, somatic concerns, mania). Given its strong psychometric performance in this study, as well as its improvements in administration and scoring, the CAPS-5-R appears to be a valuable update of the current CAPS-5.

Does COVID-19 count?: Defining Criterion A trauma for diagnosing PTSD during a global crisis.

INTRODUCTION: The ongoing coronavirus disease 2019 (COVID-19) pandemic is a globally significant crisis with a rapid spread worldwide, high rates of illness and mortality, a high degree of uncertainty, and a disruption of daily life across the sociodemographic spectrum. The clinically relevant psychological consequences of this catastrophe will be long-lasting and far-reaching. There is an emerging body of empirical literature related to the mental health aspects of this pandemic and this body will likely expand exponentially. The COVID-19 pandemic is an example of a historic catastrophe from which we can learn much and from which the field will need to archive, interpret, and synthesize a multitude of clinical and research observations. METHODS: In this commentary, we discuss situations and contexts in which a diagnosis of posttraumatic stress disorder (PTSD) may or may not apply within the context of diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria. RESULTS: Our consensus is that a COVID-related event cannot be considered traumatic unless key aspects of DSM-5's PTSD Criterion A have been established for a specific type of COVID-19 event (e.g., acute, life-threatening, and catastrophic). CONCLUSION: The application of a more liberal interpretation of Criterion A will dilute the PTSD diagnosis, increase heterogeneity, confound case-control research, and create an overall sample pool with varying degrees of risk and vulnerability factors.

Posttraumatic Stress Disorder and Suicidal Ideation: The Moderating Effect of Posttraumatic Cognitions.

Although individuals with posttraumatic stress disorder (PTSD) are at an increased risk for suicidal ideation (SI), it is unclear what factors might influence this association. Investigators have hypothesized that posttraumatic cognitions (PTCs), such as self-blame (SB) or negative cognitions about the self (NCAS) or world (NCAW), would play a role, but this has not been investigated empirically. Accordingly, we evaluated a model in which the association between PTSD symptoms and SI was moderated by PTCs in a sample of trauma-exposed undergraduate students (N = 410). To identify the specific source of this hypothesized moderation effect, we ran the moderation model separately for PTSD total severity, PTSD total severity without the cognition-related items, and each of four DSM PTSD symptom clusters in combination with each of three types of PTCs (i.e., NCAS, NCAW, SB), accounting for quadratic effects. The results revealed that NCAW moderated the positive association between all six of the PTSD variables and SI, f2 s < .01 to .04. Analyses of simple slopes generally revealed strong positive associations between PTSD symptoms with SI at high levels of NCAW, no associations at moderate levels, and negative associations at low levels. We also found one statistically significant quadratic effect when examining avoidance and NCAW. In contrast, neither NCAS nor SB emerged as a significant moderator in any of our regression models. These findings highlight the importance of addressing PTCs-particularly NCAW-in trauma survivors.

Dimensions of Growth? Examining the Distinctiveness of the Five Factors of the Posttraumatic Growth Inventory.

Posttraumatic growth, defined as positive transformation following trauma, is commonly measured using the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) and is postulated to comprise five distinct domains: Changes in Relationships, Life Possibilities, Personal Strength, Spirituality, and Appreciation of Life. However, research has indicated that the model fit is not good and the factors are highly intercorrelated. Further, no studies have formally examined the heterogeneity of correlations of the five factors with external constructs. In an effort to examine the construct validity of the five-factor model of the PTGI, the present study aimed to examine the degree to which the theorized five factors demonstrate meaningful differential associations with relevant external correlates. Participants were 400 undergraduate students who reported having experienced a stressful event and completed the Life Events Checklist for DSM-5, PTGI, Posttraumatic Stress Disorder Checklist for DSM-5, Grit Scale-12, Connor-Davidson Resilience Scale-10, and Work and Social Adjustment Scale. We found few instances of significant differentiation, and effect sizes for pairwise comparisons were generally small, Cohen's qs = 0.01-0.35. Although factor analytic evidence suggests there are five distinct underlying constructs, our results indicated that these factors do not significantly differ in their associations with external correlates. Implications for use of the PTGI and future research directions are discussed.

Development and Initial Psychometric Evaluation of the Semi-Structured Emotion Regulation Interview.

Emotion regulation (ER) strategy use has been identified as a transdiagnostic predictor of the development, maintenance, and recovery from several forms of psychopathology. However, the ER strategy use literature relies primarily on self-report measures that have several important limitations. This article describes the development and initial psychometric evaluation of a novel clinician-administered measure of ER strategy use, the Semi-Structured Emotion Regulation Interview (SERI; Lee, Weathers, & Sloan, 2016 ). The SERI was developed in a construct validation framework with emphasis on a multistage content validity process. The SERI assesses frequency and efficacy (i.e., proximal change in the targeted emotion) of 9 strategies in regulation of a specified emotion type and intensity (e.g., severe anxiety) during the past 30 days. Undergraduates (N = 68) completed a battery of self-report measures and a subsequent interview. Frequency and efficacy of each strategy was assessed separately with respect to regulation of moderate and severe anxiety and anger. Each of the assessed strategies demonstrated excellent discriminant validity. Associations between SERI and self-report measures of ER strategy use varied by target emotion type and intensity for some strategies, but not others. Implications and suggestions for future research are described.

A Factor Analytic Evaluation of the Difficulties in Emotion Regulation Scale.

OBJECTIVES: The present study aimed to elucidate the factor structure of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004)-a widely used measure of emotion dysregulation. METHOD: Participants were 3 undergraduate samples (N = 840, 78.33% female, mean age = 20.30). RESULTS: We began by using confirmatory factor analysis (CFA) to examine 3 existing models, finding that none consistently demonstrated adequate fit across samples. Subsequently, we conducted an exploratory factor analysis, identifying a novel 5-factor model that consistently resulted in adequate fit across samples. We also ran several CFA models after removing the Awareness subscale items-which have performed inconsistently in prior research-finding that a reduced-measure variant of the model retained by Gratz and Roemer (2004) resulted in adequate fit across samples. No higher-order models consistently resulted in adequate fit across samples. CONCLUSIONS: Our findings are consistent with previous work in suggesting use of a DERS total score may not be appropriate. Additionally, further work is needed to examine the novel 5-factor model and the effect of reverse-scored items on the DERS factor structure.

The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation.

The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM-correspondent self-report measure of PTSD symptoms. The PCL was recently revised to reflect DSM-5 changes to the PTSD criteria. In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM-5 (PCL-5). Psychometric properties of the PCL-5 were examined in 2 studies involving trauma-exposed college students. In Study 1 (N = 278), PCL-5 scores exhibited strong internal consistency (α = .94), test-retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM-5 4-factor model, χ2 (164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker-Lewis index (TLI) = .84, and superior fit with recently proposed 6-factor, χ2 (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7-factor, χ2 (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL-5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL-5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL-5 in a variety of assessment contexts are discussed.

Dissociation and posttraumatic stress disorder: a latent profile analysis.

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, ) contains a dissociative subtype for posttraumatic stress disorder (PTSD) characterized by significant depersonalization and derealization. In this study the PTSD dissociative subtype was examined using latent profile analysis in a sample of 541 trauma-exposed college students. Items from the PTSD Checklist and Multiscale Dissociation Inventory were used as latent class indicators. Results supported a 3-class solution including a well-adjusted class, a PTSD class, and a PTSD/dissociative class characterized by elevated symptoms of PTSD, depersonalization, and derealization. Significant class differences were found on a number of measures of related psychopathology with Cohen's d effect size estimates ranging from 0.04 to 1.86. Diagnostic and treatment implications regarding the dissociative subtype are discussed.

Diagnostic accuracy of the Composite International Diagnostic Interview (CIDI 3.0) PTSD module among female Vietnam-era veterans.

The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) posttraumatic stress disorder (PTSD) module is widely used in epidemiological studies of PTSD, yet relatively few data attest to the instrument's diagnostic utility. The current study evaluated the diagnostic utility of the CIDI 3.0 PTSD module with U. S. women Vietnam-era veterans. The CIDI and the Clinician-Administered PTSD Scale (CAPS) were independently administered to a stratified sample of 160 women, oversampled for current PTSD. Both lifetime PTSD and recent (past year) PTSD were assessed within a 3-week interval. Forty-five percent of the sample met criteria for a CAPS diagnosis of lifetime PTSD, and 21.9% of the sample met criteria for a CAPS diagnosis of past-year PTSD. Using CAPS as the diagnostic criterion, the CIDI correctly classified 78.8% of cases for lifetime PTSD (κ = .56) and 82.0% of past year PTSD cases (κ = .51). Estimates of diagnostic performance for the CIDI were sensitivity of .61 and specificity of .91 for lifetime PTSD and sensitivity of .71 and specificity of .85 for past-year PTSD. Results suggest that the CIDI has good utility for identifying PTSD, though it is a somewhat conservative indicator of lifetime PTSD as compared to the CAPS.

Prefrontal metabolite alterations in individuals with posttraumatic stress disorder: a 7T magnetic resonance spectroscopy study.

Background: Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms. Methods: Individuals with PTSD (n=27), trauma-exposed individuals without PTSD (n=27), and individuals without trauma exposure (n=26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed. Results: We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity. Conclusion: In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.

Prefrontal Metabolite Alterations in Individuals with Posttraumatic Stress Disorder: A 7T Magnetic Resonance Spectroscopy Study.

Background: Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms. Methods: Individuals with PTSD (n = 27), trauma-exposed individuals without PTSD (n = 27), and individuals without trauma exposure (n = 26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed. Results: We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity. Conclusion: In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.

A phase 3, randomized, placebo-controlled, trial to evaluate the efficacy and safety of bedtime sublingual cyclobenzaprine (TNX-102 SL) in military-related posttraumatic stress disorder.

Sleep disturbances in posttraumatic stress disorder (PTSD) are a potential target for improving PTSD severity with pharmacotherapy. TNX-102 SL is a bedtime sublingual formulation of cyclobenzaprine with potent binding and antagonist activity at 5-HT2A, α1-adrenergic, H1 histaminergic, and M1 muscarinic receptors, which play roles in the pharmacological management of sleep disturbances. This Phase 3 trial evaluated the efficacy and safety of TNX-102 SL in patients with military-related PTSD. Early and sustained improvements in sleep were associated with TNX-102 SL treatment by PROMIS Sleep Disturbance scale and Clinician Administered PTSD Scale (CAPS-5) "sleep disturbance" item, establishing a sleep quality benefit. Primary analysis comparing change from baseline in CAPS-5 total severity between TNX-102 SL and placebo at week 12 was not significant; however, week 4 was associated with an improvement. Secondary analyses showed TNX-102 SL treatment was associated with benefits on the Clinician Global Impression of Improvement at week 4 and the Patient Global Impression of Change at week 12. Time since trauma exposure was a discriminator of CAPS-5 treatment response in the subgroup ≤ 9 years since the index event. This study provides preliminary evidence that TNX-102 SL is well-tolerated and may promote recovery from PTSD by addressing sleep-related symptoms.

Factor structure of the Cambridge Depersonalization Scale in trauma-exposed college students.

This study examined the factor structure of the Cambridge Depersonalization Scale (CDS; M. Sierra & G. E. Berrios, 2000 ), a 29-item self-report measure of depersonalization. The CDS was based on a conceptualization of depersonalization as a multidimensional construct, a theoretical perspective that has received limited empirical attention. Exploratory and confirmatory factor analyses were conducted on CDS item scores in a sample of 534 trauma-exposed college students. Results failed to support factor structures of the CDS previously reported in the literature and instead supported a 2-factor solution, with 1 factor representing a sense of unreality and detachment and a 2nd factor representing emotional and physical numbing. Implications regarding the structural validity of the CDS are discussed. [Supplementary material is available for this article. Go to the publisher's online edition of Journal of Trauma & Dissociation for the following resource: Four tables with the following information: inter-correlations among CDS items from Samples 1 and 2; Sierra et al. (2005 ) four-factor model and Simeon et al. (2008 ) five-factor model estimated factor loadings, covariances, and R-square in Sample 1; Factor loadings for 3-7 factor EFA models in Sample 1; and estimated factor loadings for one-factor CFA model in Sample 2.].

Highly stressful events and posttraumatic stress disorder symptoms among veterinary professionals: Prevalence and associations with mental health and job-related outcomes.

OBJECTIVE: Explore the relationship between highly stressful events in veterinary medicine and mental health outcomes such as posttraumatic stress disorder (PTSD). METHOD: Using narratives of highly stressful work events from 359 veterinary professionals, we calculated the prevalence of PTSD using both the standard Criterion A from DSM-5-TR and an expanded definition of a traumatic event that included animals as victims. Bivariate correlations were performed to probe for relationships between exposure to highly stressful events and other negative mental health outcomes. RESULTS: Seventy-six (21.1%) veterinary professionals reported exposure to a Criterion A work-related event, and 141 (39.3%) reported exposure under the expanded definition. Further, 13 (3.6%) to 50 (13.9%) veterinary professionals screened positive for PTSD, depending on how the traumatic stressor was defined and whether PTSD symptoms were linked to the same event or multiple events. Screening positive for PTSD was positively associated with suicidal ideation, psychological distress, and burnout. Defining traumatic stressors broadly and linking PTSD symptoms to multiple events resulted in more robust correlations and revealed positive associations with depression, suicide attempt, and problematic alcohol and drug abuse. The number of exposures to highly stressful work events was also positively associated with depression, suicidal ideation, psychological distress, and burnout and negatively associated with job satisfaction. CONCLUSION: Future research should consider strategies to mitigate the negative consequences that result from unavoidable exposure to highly stressful events in the veterinary workplace. Moreover, the types of events specific to veterinary medicine should be considered when assessing for traumatic events and post-exposure symptoms in veterinary professionals. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-Rated Versus Clinician-Rated Assessment of Posttraumatic Stress Disorder: An Evaluation of Discrepancies Between the PTSD Checklist for DSM-5 and the Clinician-Administered PTSD Scale for DSM-5.

Posttraumatic stress disorder (PTSD) is commonly assessed with self-rated or clinician-rated measures. Although scores from these assessment modalities are strongly associated, they are often discrepant for individual symptoms, total symptom severity, and diagnostic status. To date, no known studies have empirically identified the sources of these discrepancies. In the present study, we had three aims: (a) replicate previously identified discrepancies; (b) examine contribution of possible objective predictors of discrepancies, including negative response bias, random responding, conscientiousness, neuroticism, and verbal IQ; and (c) identify subjective sources of discrepancies through analysis of participant feedback. Trauma-exposed undergraduates (N = 60) were administered the PTSD Checklist for DSM-5 (PCL-5), the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and other questionnaires. Interviewers identified discrepancies between corresponding PCL-5/CAPS-5 scores and asked participants to describe their attributions for discrepancies. Discrepancies, both dimensional and dichotomous, occurred at the item, cluster, and total score level. Objective predictors were weakly associated with discrepancies. The most commonly reported reasons for discrepancies were time-frame reminders, comprehension of symptoms, trauma-related attribution errors, increased awareness, and general errors. These findings help explain discordance between the PCL-5 and CAPS-5, and inform use and interpretation of these two widely used PTSD measures in clinical and research applications.

Design and methods of a randomized controlled trial evaluating the effects of the PE Coach mobile application on prolonged exposure among veterans with PTSD.

BACKGROUND: Little is known about the impact of mobile applications (apps) designed to support patients progressing through an evidence-based psychotherapy. Prolonged exposure (PE) is an efficacious treatment for posttraumatic stress disorder (PTSD) and PE Coach is a treatment companion app that may increase patient engagement with the active components of PE, thereby supporting recovery. METHODS: This paper describes a randomized clinical trial that will evaluate PE delivered with and without PE Coach at post-treatment, and 1-month and 4-months post-treatment. Veterans with PTSD (N = 124) will be randomized (1:1) to conditions and complete up to 15 treatment sessions based on a priori defined termination criteria. We hypothesize that compared to PE without PE Coach, PE with the app will result in greater improvements in PTSD-related social and occupational functioning (primary outcome is the PTSD-Related Functioning Inventory), quality of life, and greater reductions in functional impairment, neurobehavioral symptoms, depression, and suicidal ideation (Aim 1). We also hypothesize that including PE Coach will reduce assessor-masked PTSD symptom severity, relative to PE without the app, as assessed by the revised Clinician-Administered PTSD Scale for DSM-5 (Aim 2). We hypothesize that PE Coach will facilitate increased treatment adherence, as measured by completion of PE homework (Aim 3). We will explore the impact of PE Coach on treatment engagement, as measured by reduced treatment dropout. CONCLUSION: Data on the outcomes of PE Coach can inform dissemination efforts and help evaluate the return on investment to guide future mental health app development. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.govNCT04959695.

An Item Response Theory Analysis of the Clinician-Administered PTSD Scale for DSM-5 Among Veterans.

We used item response theory (IRT) analysis to examine Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) item performance using data from three large samples of veterans (total N = 808) using both binary and ordinal rating methods. Relative to binary ratings, ordinal ratings provided good coverage from well below to well above average within each symptom cluster. However, coverage varied by cluster, and item difficulties were unevenly distributed within each cluster, with numerous instances of redundancy. For both binary and ordinal scores, flashbacks, dissociative amnesia, and self-destructive behavior items showed a pattern of high difficulty but relatively poor discrimination. Results indicate that CAPS-5 ordinal ratings provide good severity coverage and that most items accurately differentiated between participants by severity. Observed uneven distribution and redundancy in item difficulty suggest there is opportunity to create an abbreviated version of the CAPS-5 for determining PTSD symptom severity, but not DSM-5 PTSD diagnosis, without sacrificing precision.

Association of life threat and betrayal with posttraumatic stress disorder symptom severity.

The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) emphasizes life threat as the defining feature of psychological trauma. Recent theoretical and empirical work, however, indicates the need to identify and evaluate other key aspects of trauma. Betrayal has been proposed as a pertinent, distinct, and complementary factor that can explain effects of trauma not accounted for by life threat alone. This study examined the relationship between injury, perceived life threat (PLT), and betrayal with posttraumatic stress disorder (PTSD) symptom severity. Trauma-exposed college students (N = 185) completed self-report measures of trauma exposure and PTSD, as well as items regarding life threat, betrayal, and level of medical care received. In hierarchical regressions incorporating injury, PLT, and betrayal, betrayal was associated with all PTSD symptom clusters and PTSD total severity (f(2) = .08), whereas PLT was associated with hyperarousal (f(2) = .05) and PTSD total (f(2) = .03), and injury had no association with PTSD symptoms. In a revised model with trauma type as an additional variable, betrayal was associated with avoidance (f(2) = .03), numbing (f(2) = .04), and PTSD total (f(2) = .03), whereas PLT was associated with reexperiencing (f(2) = .04), hyperarousal (f(2) = .04), and PTSD total (f(2) = .03), and injury was associated with avoidance (f(2) = .03). These findings support the idea that betrayal is a core dimension of psychological trauma that may play an important role in the etiology of PTSD.

Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: a cluster-randomized trial.

Posttraumatic stress disorder (PTSD) is one of the fastest growing compensated medical conditions. The present study compared usual disability examiner practices for PTSD with a standardized assessment that incorporates evidence-based assessments. The design was a multicenter, cluster randomized, parallel-group study involving 33 clinical examiners and 384 veterans at 6 Veterans Affairs medical centers. The standardized group incorporated the Clinician Administered PTSD Scale and the World Health Organization Disability Assessment Schedule-II into their assessment interview. The main outcome measures were completeness and accuracy of PTSD diagnosis and completeness of functional assessment. The standardized assessments were 85% complete for diagnosis compared to 30% for nonstandardized assessments (p < .001), and, for functional impairment, 76% versus 3% (p < .001). The findings demonstrate that the quality of PTSD disability examination would be improved by using evidence-based assessment.

Construct validity of three depersonalization measures in trauma-exposed college students.

Depersonalization is a type of dissociation characterized by feelings of unreality and detachment from one's sense of self. Despite a history rich in clinical description, the construct of depersonalization has proven difficult to define and measure. Available measures vary substantially in content, and all have relatively limited psychometric support. In this study the content validity, internal consistency, and convergent and discriminant validity of 3 depersonalization measures were compared in a sample of 209 trauma-exposed college students. Measures were the Dissociative Experiences Scale ( E. M. Bernstein & F. W. Putnam, 1986 ), Cambridge Depersonalization Scale (CDS; M. Sierra & G. E. Berrios, 2000 ), and Multiscale Dissociation Inventory (MDI; J. Briere, 2002 ). All 3 measures exhibited adequate to high internal consistency for the depersonalization-derealization items. Based on D. Westen and R. Rosenthal's (2003) procedure for quantifying construct validity, the CDS and MDI demonstrated the best fit with the predicted pattern of correlations with measures of other constructs. The CDS and MDI also demonstrated the strongest evidence of content validity. Overall, the results most strongly support the use of the CDS and MDI for assessing depersonalization in this population.