Post-traumatic stress disorder: Evidence for diagnostic validity and methods of psychological assessment

Abstract

Post‐traumatic stress disorder (PTSD) is a diagnosis that has been the subject of considerable criticism in the clinical literature. Of primary concern has been the question of whether PTSD is a disorder that can be discriminated reliably from already existing diagnoses, such as depression, dysthymia, or generalized anxiety disorder. This paper reviews the evidence that surrounds this controversy and employs the guidelines for validating a diagnosis established by Robins and Guze (1970) as the framework for the review. A second purpose of this paper is to present a multiaxial approach for the assessment of PTSD. This approach includes the use of structured interviews, psychometrics, and a psychophysiological assessment procedure. Studies that support the reliability and validity of the components of the multiaxial method are reviewed.

Personality Assessment Inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: Associations with aggression

“…From this perspective, broad-based measures of psychopathology and personality may be useful in assessing comorbid psychiatric symptoms that explain variance in behavioral difficulties such as aggression among help-seeking patients with PTSD. Indeed, the use of broadband measures of psychopathology have been recommended as part of best practices in the assessment of PTSD to aid in the identification of comorbid psychiatric symptoms (Keane, Wolfe, & Taylor, 1987).…”

The Role of Craniocerebral Trauma in the Dynamics of Combat-Related Post-Traumatic Stress Disorder

“…The Mississippi Scale for Combat-Related PTSD was developed to evaluate the severity of post-traumatic stress reactions in combat veterans [40,41]. The scale was used in our studies to verify diagnoses of PTSD.…”

Utility: Sensitivity and specificity in developing diagnostic tests of combat-related Post-Traumatic Stress Disorder (PTSD)

“…We recommend the procedure of (a) working with expert clinicians experienced in diagnosing and treating PTSD; (b) obtaining classification from multiple procedures obtained independently; and (c) using one of the better-developed standards, such as the Structured Interview for DSM-III-Revised (Spitzer & Williams, 1985), with standardized checklist and ratings, or the Jackson Interview. (See Keane et al, 1987, for a review.) Table 2 reflects too much heterogeneity in terms of the Index Diagnosis; uniformity is recommended.…”

“…The goal of this paper is to review representative and prototypical diagnostic tests of PTSD currently under development, with particular attention to those tests that have been assessed for clinical utility in terms of sensitivity and specificity. This paper will not report studies that test differences between groups with and without PTSD: For that literature, the reader is referred to previously published summaries (e.g., Keane, Wolfe, & Taylor, 1987, in the first monograph in this series). Nor will this paper recommend one PTSD diagnostic test over another.…”