TPC-Journal-V4-Issue2

The Professional Counselor \Volume 4, Issue 2 115 to an external event rather than an anxiety related to mental illness (Staggs, 2014). The DSM-5 provides eight clear criteria for diagnosing PTSD, beginning with identifying a traumatic event (criterion A) and then noting behavioral symptoms related to PTSD. It organizes symptoms into four clusters: intrusions (criterion B), avoid- ance (criterion C), negative symptoms (criterion D), and arousal (criterion E) (American Psychological Associa- tion, 2013). In order for a client to meet the full criteria for a PTSD diagnosis, his or her symptoms must last longer than a month (criterion F), must prevent him or her from functioning well in significant area(s) of life (criterion G), and cannot be due to physical factors such as a medical condition or substance use (criterion H). The National Center for PTSD (2014a) provides guidelines for diagnosing PTSD using the DSM-5 . Crite- rion A (stressor) indicates that the person was exposed to at least one of the following: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. The person must persistently re- experience at least one of the intrusion symptoms (criterion B) of the traumatic event and one of the avoidance efforts (criterion C) of distressing trauma-related stimuli. Two negative symptoms or alterations in cognition or mood (criterion D) and two alterations in arousal and reactivity (criterion E) that began or worsened after the traumatic event must be present for a diagnosis of PTSD. Although symptoms may occur soon after the event, a person does not qualify for a PTSD diagnosis until at least six months after the traumatic event. An individual with PTSD will experience high levels of either depersonalization or derealization (National Center for PTSD, 2014a). Nussbaum’s (2013) brief version for diagnosing PTSD begins by asking the following: What is the worst thing that has ever happened to you? Have you ever experienced or witnessed an event in which you were seriously injured or your life was in danger, or you thought you were going to be seri- ously injured or endangered? (p. 90) If the client answers in the affirmative, the counselor is to ask these questions: “Do you think about or re-expe- rience these events? Does thinking about these experiences ever cause significant trouble with your friends or family, at work, or in another setting?” (Nussbaum, 2013, p. 90). Nussbaum (2013) provides a set of questions for each cluster and its associated symptoms to guide the process of diagnosis. Assessment Tools Ottati and Ferraro (2009) describe three assessment tools, validated on veteran populations, to screen for combat-related PTSD: the 17-item self-report PTSD Checklist (PCL) , the 35-item self-report Mississippi Scale for Combat-Related PTSD (M-PTSD) , and the Clinician-Administered PTSD Scale (CAPS). The PCL was re- cently updated to 20 items to reflect the changes in DSM-5 . PCL-5 is a self-report measure that takes 5–10 min- utes to complete and may be used to screen, diagnose and monitor changes during and after treatment of PTSD (Weathers et al., 2013). The M-PTSD uses a 5-point Likert scale to rate PTSD symptoms and related symptoms of substance abuse, suicidal ideation, and depression. It provides a PTSD symptom severity index with scores ranging from 35–175. The M-PTSD has not been revised since DSM-3 , but may still be useful since it was normed with veteran populations (National Center for PTSD, 2014b). CAPS is a diagnostic structured interview that also measures the severity of symptoms and was recently revised to assess the DSM-5 PTSD symptoms. CAPS-5 is a 30-item questionnaire that takes 45–60 minutes to administer and yields a single score of PTSD severity (Weathers et al., 2013). Other instruments are available to counselors for consideration. The PTSD Symptom Scale, Interview Ver- sion (PSS-I) with 17 items is a shorter clinical interview comparable to CAPS (Peterson, Luethcke, Borah, Borah, & Young-McCaughan, 2011). The PSS-I can be administered in about 20 minutes by a trained lay interviewer, and each item consists of a brief question so that an initial assessment can be made in shorter time