Recommendations from the National Institute of Mental Health National Center for PTSD Conference

In November 1995, 45 clinicians and researchers from around the world met in Boston, Massachusetts, in conjunction with the annual meeting of the International Society for Traumatic Stress Studies, to discuss and debate various approaches to the assessment of PTSD (Keane, Solomon, Maser, & Gerrity, 1995b). Although their task was to provide guidance for conducting clinical research in the field, their recommendations relate to the development of standards for assessing PTSD in many different settings and for a variety of purposes. The conference participants reached consensus on several parameters of the assessment process. Those relevant to the selection of measures to assess PTSD and symptom severity are described below.

1. Clinician-administered structured diagnostic interviews provide valuable clinical information. The clinician should evaluate their quality, using the psychometric properties of reliability, validity, and clinical utility as a guideline.

2. Structured diagnostic interviews that provide both a dichotomous and continuous rating of PTSD symptoms are preferred.

3. The dimensions of symptom frequency, intensity, and duration of a particular episode should be assessed. Levels of distress, as articulated by the patient regarding his or her symptom, are important to identify.

4. Ratings of impairment and disability secondary to the symptom complex provide important information regarding the severity of the condition.

5. Measures that evaluate both the components of the traumatic event (i.e., A1) and the severity of thr reaction to that event (i.e., A2) are essential.

6. Instruments whose reliability and validity studies contain information regarding instrument performance across gender, racial, and ethnic groups are preferred, especially evaluating males and females of different cultures and races.

7. Self-report instruments for PTSD should meet the standards for psychometric instruments established by the American Psychological Association's "Standards for Educational and Psychological Tests."

8. The events identified as key to review when examining for the presence of traumatic events include war-zone stressors, sexual assault in childhood or adulthood, robberies, accidents, technological disasters, natural disasters or hazardous exposures, sudden death of a loved one, life-threatening illnesses, and witnessing or experiencing violence. In general, the committee recommended that "in depth questions need to be asked about event occurrences, perceived life threat, harm, injuries, frequency, duration, and age."

9. The committee also recommended that comorbidity be closely examined because response to treatment can vary depending upon the presence of additional psychological conditions. The committee recommended a full assessment of Axis I disorders using a structured clinical interview, such as the Structured Clinical Interview for the DSM (First, Spitzer, Williams, & Gibbon, 2000) or something comparable in scope and efficiency.

10. Finally, the committee recommended that "in evaluating stressors, careful behaviorally-anchored terminology should be used, avoiding jargon such as abuse, rape, etc., terms which are inherently imprecise and not universally understood in the same way within and across cultures."

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