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Identifying Trauma-Related Assessment Instruments

While the Military has developed systems for evaluating Service Members’ readiness for return to duty, the question of readiness for return to civilian life is a bit less clear. The Armed Forces have implemented universal screening processes in their primary care settings to try to reduce stigma and make it easier for veterans who need services to seek them. Civilian clinicians in SUD treatment and mental health can also do their part, by becoming familiar with the instruments used to identify and diagnose the range of post-deployment stress effects.

Begin With an Assessment of Strengths: The weight of contemporary knowledge of trauma is overwhelming. As young as our collective understanding of this subject is, experts have managed to put together exhaustive lists of symptoms, signs, and gut-wrenching experiences in the theater of war. All of this information is essential, but even the most compassionate assessment process can drive the stigma and shame deeper into the veteran’s heart, without ever intending that consequence.

The fields of mental health and substance use disorders have learned the hard way that a focus on the problem must be well balanced—and even preceded—by a focus on the individual’s strengths, resources, and resilience. In recovery-based approaches toward the care of SUDs, clinicians and recovery mentors alike are learning to begin the assessment process with an inventory of strengths and resources, also called “recovery capital.” The collection of this information is then used to feed the treatment planning process, and to help remind clients of the equally overwhelming reality of recovery (White, Kurtz, and Sanders, 2006; White, 2007).

Screening and Assessment Instruments: The Department of Veterans Affairs (VA) National Center for Posttraumatic Stress Disorder (NCPTSD) provides a wide variety of trauma screening instruments, trauma exposure measures (to identify traumatic events experienced), and PTSD measures (to identify symptoms related to those events).

These instruments vary widely in terms of the time it takes to administer them, length, complexity, thoroughness, sophistication, measurement of symptom severity/frequency, reading level, and cost. They also differ in terms of the range of trauma types screened for or assessed. It is important to find a balance between the desire for a manageable assessment process that is acceptable to the client with the need for accurate assessment of people whose symptoms may not always fit neatly into the restrictive diagnostic criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders.

Even if war exposure is the factor that triggers the trauma, the history of earlier childhood trauma can influence the direction and course of post-trauma effects. So along with the traditional PTSD symptoms (fear, avoidance, hyperarousal), it is also important to assess challenges in emotion regulation, consciousness, relationships, and meaning/spirituality (Ford and Kidd, 1998).

If complex PTSD or DESNOS might be an issue, the SIDES scale can be used after a careful, developmentally based trauma history to capture information on the overall effects of trauma. The SIDES scale was developed based on seven categories of clinically relevant issues that were not included in PTSD diagnostic criteria, but were identified during the DSM-IV field trials for PTSD. Most of the symptoms listed in the SIDES are included in other DSM diagnoses, e.g., dissociative disorder, somatization disorder, various Axis II personality disorders, and as “associated features” under PTSD (van der Kolk and Pelcovitz, 1999).

The 27 diagnostic criteria addressed in the SIDES are organized in seven categories:

  1. Alteration in regulation of affect and impulses
  2. Alterations in attention or consciousness
  3. Alteration in self-percetion
  4. Alterations in perception of the perpetrator
  5. Alterations in relationships with others
  6. Somatization
  7. Alterations in systems of meaning (van der Kolk and Pelcovitz, 1999)

View Suicide Risk Assessment With the SAFE-T Card

Global Assessment Processes: Friedman (2006) cautions that people diagnosed with PTSD have an 80-percent chance of meeting diagnostic criteria for at least one other psychiatric disorder. He recommends a wide-ranging assessment process that includes all of the following.

Risk and protective factors to assess:

  • risk of suicide
  • danger to others
  • ongoing stressors
  • risky behaviors
  • personal characteristics
    • coping skills
    • ways of relating to others
    • attachment
    • shame
    • sensitivity to stigma
    • past trauma history
    • motivation for treatment
  • social support
  • other psychiatric and medical disorders

Other issues to assess:

  • experience of stigma within the military
  • National Guard or military reserve service
  • military sexual trauma
  • survival of serious injury

Next: Choosing Safe and Appropriate
Treatment Interventions


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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