Guides trauma-informed assessment with PTSD screening and trauma history documentation. Use when assessing trauma exposure, screening for PTSD, or documenting trauma history.
Guides trauma-informed assessment with PTSD screening using validated instruments, comprehensive trauma history documentation, and differential diagnosis aligned with VA/DoD Clinical Practice Guidelines and APA PTSD Treatment Guidelines.
Why This Skill Exists
Trauma exposure is nearly universal — approximately 70% of adults worldwide experience at least one traumatic event in their lifetime. While most individuals are resilient, 6-8% of the US population will develop PTSD, with significantly higher rates in military veterans (15-30%), sexual assault survivors (30-50%), and first responders. Trauma's psychiatric impact extends well beyond PTSD: Complex PTSD, major depression, substance use disorders, dissociative disorders, somatic symptom disorders, and personality pathology are all trauma-related sequelae.
The VA/DoD Clinical Practice Guideline for PTSD (2023) and APA PTSD Treatment Guidelines mandate structured, validated assessment using instruments such as the PCL-5 (PTSD Checklist for DSM-5), CAPS-5 (Clinician-Administered PTSD Scale), and the Life Events Checklist. Trauma-informed assessment principles require that the evaluation process itself not re-traumatize the patient. Inadequate trauma assessment leads to missed diagnoses, inappropriate treatment (e.g., benzodiazepines for PTSD, which worsen outcomes), and failure to connect symptoms across multiple body systems to their traumatic etiology.
관련 스킬
Checkpoint A: Pre-Draft Intake (Mandatory)
What is the assessment context? (clinical evaluation, disability claim, forensic evaluation, treatment planning, pre-therapy intake) — default: clinical evaluation
What type of trauma is reported or suspected? (combat, sexual assault, childhood abuse/neglect, intimate partner violence, accident, natural disaster, medical trauma, community violence) — default: assess broadly
Is the trauma ongoing or has it ended? (critical for safety planning) — default: assess immediately
What is the patient's current safety status? (safe environment, ongoing threat, active DV, active military deployment) — default: assess
Does the patient have a known dissociative disorder or high dissociation? (affects assessment approach) — default: screen
Has the patient been previously diagnosed with PTSD or trauma-related conditions? — default: obtain history
What validated instruments are available? (PCL-5, CAPS-5, LEC-5, CTQ, DES-II) — default: PCL-5 and LEC-5
Is the patient currently in substance use or actively suicidal? (stabilize before trauma processing) — default: assess
Documents to Request
Life Events Checklist (LEC-5) completed by patient
PCL-5 (PTSD Checklist for DSM-5) completed by patient
Prior psychological evaluations and PTSD assessments
Military service records and DD-214 (for veterans)
VA disability claim records if applicable
Police reports, protective orders, or legal documentation of trauma
Medical records documenting injuries consistent with reported trauma
Child protective services records if childhood maltreatment
Prior therapy records (especially trauma-focused therapy)
Substance use treatment records
Step 1: Trauma Exposure Assessment
Administer the Life Events Checklist for DSM-5 (LEC-5):
17 trauma categories (natural disaster, fire/explosion, transportation accident, serious accident, exposure to toxic substance, physical assault, assault with weapon, sexual assault, unwanted sexual experience, combat exposure, captivity, life-threatening illness/injury, severe human suffering, sudden violent death, sudden accidental death, serious harm/death you caused, any other very stressful event)
For each: happened to me, witnessed it, learned about it, part of my job, not sure, doesn't apply
Extended Criterion A Assessment: For the worst event, assess directly experienced, witnessed, learned about close family/friend, repeated/extreme exposure in professional role
For childhood trauma, administer the Childhood Trauma Questionnaire (CTQ):
28 items across 5 scales: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect
Each rated 1 (never true) to 5 (very often true)
Severity cutoffs: None/minimal, Low/moderate, Moderate/severe, Severe/extreme per subscale
Document each traumatic event with:
Type of trauma and age at occurrence
Duration (single incident vs. chronic/repeated)
Relationship to perpetrator (if interpersonal)
Whether the patient received treatment at the time
Impact on developmental trajectory (for childhood traumas)
Step 2: PTSD Symptom Assessment
PCL-5 (PTSD Checklist for DSM-5) — Self-Report Screening
20 items corresponding to DSM-5-TR PTSD criteria
Each rated 0 (not at all) to 4 (extremely) for past month
Can also score by DSM-5-TR symptom clusters for diagnostic alignment
CAPS-5 (Clinician-Administered PTSD Scale) — Gold Standard Diagnostic Interview
30 items assessing frequency AND intensity of each PTSD symptom
Severity rating: 0-4 per item
Diagnostic rule: At least 1 Criterion B, 1 C, 2 D, and 2 E symptoms rated ≥2 (moderate)
Total severity score: Sum of 20 core items (range 0-80)
Includes dissociative subtype assessment
DSM-5-TR PTSD Criteria (F43.10)
Criterion A — Traumatic Exposure: Exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, learning about close family/friend, or repeated professional exposure.
Criterion B — Intrusion (≥1 required): Recurrent intrusive memories, distressing dreams, dissociative reactions (flashbacks), intense distress at reminders, marked physiological reactions to reminders.
Criterion C — Avoidance (≥1 required): Avoidance of distressing memories/thoughts/feelings, avoidance of external reminders (people, places, activities, situations).
Criterion D — Negative Cognitions and Mood (≥2 required): Inability to remember key aspects of trauma, persistent negative beliefs about self/others/world, distorted cognitions about cause/consequences, persistent negative emotional state, diminished interest, feelings of detachment, persistent inability to experience positive emotions.
Criterion E — Arousal and Reactivity (≥2 required): Irritable behavior/angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle, concentration problems, sleep disturbance.
Criterion F: Duration >1 month
Criterion G: Clinically significant distress or functional impairment
Criterion H: Not attributable to substance or medical condition
Specifiers: Dissociative subtype (depersonalization or derealization), delayed expression (full criteria not met until ≥6 months after trauma)
Step 3: Comorbidity and Differential Diagnosis Assessment
Screen for conditions commonly comorbid with or mimicking PTSD:
Major Depressive Disorder: PHQ-9. Overlapping symptoms: anhedonia, sleep disturbance, concentration difficulty, negative cognitions. MDD comorbidity rate in PTSD: ~50%.
Substance Use Disorders: AUDIT, DAST-10. Self-medication is common. Comorbidity rate: 25-50%.
Traumatic Brain Injury: Overlapping symptoms (concentration, irritability, sleep disturbance, memory problems). Screen with Ohio State TBI Identification Method.
Panic Disorder: Panic attacks triggered by trauma reminders vs. spontaneous panic attacks.
Generalized Anxiety Disorder: GAD-7. Chronic worry vs. trauma-specific hyperarousal.
Acute Stress Disorder: Same symptom clusters but duration 3 days to 1 month post-trauma.
Adjustment Disorder: Distress after stressor that does not meet Criterion A for PTSD.
Complex PTSD (ICD-11): PTSD symptoms PLUS affect dysregulation, negative self-concept, interpersonal difficulties. Use ITQ (International Trauma Questionnaire).
Childhood trauma assessed (CTQ or clinical history)
Evidence-based treatment recommended with guideline citation
Benzodiazepine contraindication noted in treatment plan
Guidelines
Never prescribe benzodiazepines as first-line or monotherapy for PTSD — they worsen outcomes, impair fear extinction learning, and increase risk of substance dependence per VA/DoD CPG (strong against recommendation).
Always assess for ongoing safety threats before initiating trauma-focused therapy — active trauma (ongoing DV, combat deployment) requires safety planning and stabilization before trauma processing.
Use trauma-informed assessment practices — provide choice and control during the interview, explain the purpose of trauma questions, allow the patient to pace disclosure, and do not require detailed trauma narrative during initial screening.
Screen for dissociation before starting trauma-focused therapy — highly dissociative patients may require a stabilization phase (grounding, affect regulation skills) before exposure-based treatments.
PTSD assessment in veterans must account for military sexual trauma (MST) — screen for MST specifically, as it is frequently undisclosed and carries distinct treatment implications.
Document the index trauma clearly for treatment planning — the specific trauma(s) targeted in CPT or PE must be identified during assessment.
When PTSD and SUD co-occur, integrated treatment models are preferred — sequential treatment (requiring sobriety before trauma therapy) is no longer recommended. Seek Safety, CPT, and PE can be delivered concurrently with SUD treatment.