Posttraumatic stress disorder: Patient interview, clinical assessment, and diagnosis

Although the vast majority of the population is exposed to traumatic stress at some point in life, only a relatively small percentage of exposed individuals develop posttraumatic stress disorder (PTSD; Ozer, Best, Lipsey, & Weiss, 2003). Research has identified a number of pre-, peri-, and posttraumatic factors that contribute to an individual’s failure to recover naturally after a trauma. Pretrauma factors that increase risk for PTSD include female gender; younger age at the time of stressor exposure; racial or ethnic minority status (Brewin, Andrews, & Valentine, 2000; Ozer et al., 2003); previous trauma exposure (Delahanty, Raimonde, Spoonster, & Cullado, 2003; King, King, Foy, & Gudanowski, 1996; Nishith, Mechanic, & Resick, 2000); a family history of psychiatric problems (Breslau, Davis, Andreski, & Peterson, 1991); psychopathology before trauma (e.g., Blanchard, Hickling, Taylor, & Loos, 1995; Bromet, Sonnega, & Kessler, 1998); dysfunction in the family of origin, such as childhood abuse or family instability (Andrews, Brewin, Rose, & Kirk, 2000; King et al., 1996); and genetic vulnerability (e.g., Cornelis, Nugent, Amstadter, & Koenen, 2010). Peritraumatic risk factors for PTSD include trauma severity, perceived threat of injury or death (e.g., King, King, Gudanowski, & Vreven, 1995; King, King, Salgado, & Shalev, 2003), peritraumatic dissociation (e.g., Ozer et al., 2003), intense emotional responses (e.g., shame, guilt, generalized fear; Ozer et al., 2003), and exposure to grotesque events (e.g., Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Finally, research has shown that posttrauma social support, or lack thereof, is associated with PTSD (Ozer et al., 2003). This chapter describes common risk factors for PTSD and some of the changes to the PTSD diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5; American Psychiatric Association, 2013). We also review some of the available self-report questionnaires and diagnostic interviews that clinicians can use in a thorough evaluation of stressor exposure, PTSD symptoms, and associated functional impairment. Recommendations are made about when to use each measure, as well as how to interpret responses to inform clinical decisions. (PsycInfo Database Record (c) 2025 APA, all rights reserved) (Source: create)