Clinician-Administered PTSD Scale for DSM-IV - Part 1

Transcription

1 UW ADAI Sound Data Source Clinician-Administered PTSD Scale for DSM-IV - Part 1 Protocol Number: XXXXXXXX-XXXX a Participant #: d Form Completion Status: 1=CRF administered 2=Participant refused 3=Staff member did not administer 4=Not enough time to administer 5=No participant contact e 6=Other (specify: ) i Node #: b Name Code: j Site #: c Visit #: f g h Visit Date: / / Listed below are a number of difficult or stressful things that sometimes happen to people. For each event check one or more of the boxes to indicate that: (a) it happened to you personally, (b) you witnessed it happen to someone else, (c) you learned about it happening to someone close to you, (d) you're not sure if it fits, or (e) it doesn't apply to you. Be sure to consider your entire life (growing up as well as adulthood) as you go through the list of events. LIFE EVENTS CHECKLIST 1. Natural disaster (i.e., flood, hurricane, tornado, earthquake) Happened to me: 1 Witnessed it: 2 Learned about it: 3 Not sure 1 Doesn't apply 1 2. Fire or explosion Happened to me: Witnessed it: Learned about it: 7 8 Not sure 1 Doesn't apply CAPS, Part 1 no table v1.2 05/17/2004 Page 1

2 3. Transportation accident (i.e., car accident, boat accident, train wreck, plane crash) Happened to me: 11 Witnessed it: 12 Learned about it: Serious accident at work, home, or during recreational activity Happened to me: Not sure 1 Doesn't apply Witnessed it: Learned about it: Exposure to toxic substance (i.e., dangerous chemicals, radiation) Happened to me: Not sure 1 Doesn't apply Witnessed it: Learned about it: Physical assault (i.e., being attacked, hit, slapped, beaten up, kicked) Happened to me: Not sure 1 Doesn't apply Witnessed it: Learned about it: Not sure 1 Doesn't apply CAPS, Part 1 no table v1.2 05/17/2004 Page 2

3 7. Assault with a weapon (i.e., being shot, stabbed, threatened with a knife, gun, bomb) Happened to me: 31 Witnessed it: 32 Learned about it: Sexual assault (i.e., attempt to rape, made to perform any type of sexual act through force or threat of harm) Happened to me: Not sure 1 Doesn't apply Witnessed it: Learned about it: Not sure 1 Doesn't apply 1 9. Other unwanted or uncomfortable sexual experience Happened to me: Witnessed it: Learned about it: Combat or exposure to a war zone (in the military or as a civilian) Happened to me: Not sure 1 Doesn't apply Witnessed it: Learned about it: Not sure 1 Doesn't apply 1 CAPS, Part 1 no table v1.2 05/17/2004 Page

4 11. Captivity (i.e., being kidnapped, abducted, held hostage, prisoner of war) Happened to me: 51 Witnessed it: 52 Learned about it: 53 Not sure 1 Doesn't apply Life threatening illness or injury Happened to me: Witnessed it: Learned about it: Not sure 1 Doesn't apply Severe human suffering Happened to me: Witnessed it: Learned about it: Not sure 1 Doesn't apply Sudden, violent death (i.e., homicide, suicide) Happened to me: Witnessed it: Learned about it: Not sure 1 Doesn't apply 1 CAPS, Part 1 no table v1.2 05/17/2004 Page

5 15. Sudden, unexpected death of someone close to you Happened to me: 71 Witnessed it: Learned about it: Serious injury, harm, or death you caused to someone else Happened to me: Not sure 1 Doesn't apply Witnessed it: Learned about it: Not sure 1 Doesn't apply Any other stressful event or experience Happened to me: Witnessed it: Learned about it: Not sure 1 Doesn't apply Completed by (Staff #): Reviewed by (Staff #): Entered by (Staff #): CAPS, Part 1 no table v1.2 05/17/2004 Page 5

6 UW ADAI Sound Data Source Clinician-Administered PTSD Scale for DSM-IV - Part 2 Protocol Number: XXXXXXXX-XXXX a Participant #: d Form Completion Status: 1=CRF administered 2=Participant refused 3=Staff member did not administer 4=Not enough time to administer 5=No participant contact e 6=Other (specify: ) i Node #: b Name Code: j Site #: c Visit #: f g h Visit Date: / / I m going to be asking you about some difficult or stressful things that sometimes happen to people. Some examples of this are being in some type of serious accident; being in a fire, a hurricane, or an earthquake; being mugged or beaten up or attacked with a weapon; or being forced to have sex when you didn t want to. I ll start by asking you to look over a list of experiences like this and check any that apply to you. Then, if any of them do apply to you, I ll ask you to briefly describe what happened and how you felt at the time. Some of these experiences may be hard to remember or may bring back uncomfortable memories or feelings. People often find that talking about them can be helpful, but it s up to you to decide how much you want to tell me. As we go along if you find yourself becoming upset, let me know and we can slow down and talk about it. Also, if you have any questions or you don t understand something, please let me know. Do you have any questions before we start? 1. CRITERION A: CRITERION A: The person has been exposed to a traumatic event in which both of the following were present: (A1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and (A2) the person s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. Administer Life Events Checklist (CAPS, Part 1), then review and inquire up to 3 events. If more than 3 events are endorsed, determine which 3 events to inquire (e.g., first, worst, and most recent events; 3 worst events; trauma of interest plus 2 other events, etc.). If no events endorsed on CAPS, Part 1: 1. Has there ever been a time when your life was in danger or you were seriously injured or harmed? If NO, continue to Question 2. 1 CAPS, Part 2 v1.1 05/17/2004 Page 1

7 2. What about a time when you were threatened with death or serious injury, even if you weren t actually injured or harmed? If NO, continue to Question What about witnessing something like this happen to someone else or finding out that it happened to someone close to you? If NO, continue with Question What would you say are some of the most stressful experiences you have had over your life? 4 EVENT #1: 5. What happened? (How old were you? Who else was involved? How many times did this happen? Life threat? Serious injury? Describe event (e.g., event type, victim, perpetrator, age, frequency).) 5 6. How did you respond emotionally? (Were you very anxious or frightened? Horrified? Helpless? How so? Were you stunned or in shock so that you didn t feel anything at all? What was that like? What did other people notice about your emotional response? What about after the event - how did you respond?) 6 Complete Questions 7-9 based on participant s description of Event #1. 7. Criterion A1: a. Life threat? If Yes: Self 1 Other 2 b. Serious injury? If Yes: Self 1 Other 2 c. Threat to physical integrity? CAPS, Part 2 v1.1 05/17/2004 Page 2

8 If Yes: 8. Criterion A2: Intense fear/helplessness/horror? If Yes: Self 1 Other 2 During 1 After 2 9. Criterion A met? Probable EVENT #2: 10. What happened? (How old were you? Who else was involved? How many times did this happen? Life threat? Serious injury? Describe event (e.g., event type, victim, perpetrator, age, frequency).) How did you respond emotionally? (Were you very anxious or frightened? Horrified? Helpless? How so? Were you stunned or in shock so that you didn t feel anything at all? What was that like? What did other people notice about your emotional response? What about after the event - how did you respond?) Complete Questions based on participant s description of Event # Criterion A1: a. Life threat? If Yes: Self 1 Other 2 b. Serious injury? If Yes: Self 1 Other 2 c. Threat to physical integrity? If Yes: Self 1 Other CAPS, Part 2 v1.1 05/17/2004 Page 3

9 13. Criterion A2: Intense fear/helplessness/horror? If Yes: During 1 After Criterion A met? Probable C. EVENT #3: 15. What happened? (How old were you? Who else was involved? How many times did this happen? Life threat? Serious injury? Describe event (e.g., event type, victim, perpetrator, age, frequency).) How did you respond emotionally? (Were you very anxious or frightened? Horrified? Helpless? How so? Were you stunned or in shock so that you didn t feel anything at all? What was that like? What did other people notice about your emotional response? What about after the event - how did you respond?) 28 Complete Questions based on participant s description of Event # Criterion A1: a. Life threat? If Yes: Self 1 Other 2 b. Serious injury? If Yes: Self 1 Other 2 c. Threat to physical integrity? If Yes: Self 1 Other Criterion A2: Intense fear/helplessness/horror? CAPS, Part 2 v1.1 05/17/2004 Page 4

10 If Yes: During 1 After Criterion A met? Probable CRITERION B CRITERION B: The traumatic event is persistently reexperienced in one (or more) of the following ways: (B1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. For the rest of the interview, I want you to keep (EVENTS) in mind as I ask you some questions about how they may have affected you. I m going to ask you about twenty-five questions altogether. Most of them have two parts. First, I ll ask if you ve ever had a particular problem, and if so, about how often in the past month (week). Then I ll ask you how much distress or discomfort that problem may have caused you. 20. Have you ever had unwanted memories of (EVENT)? What were they like? (What did you remember?) [If not clear:] (Did they ever occur while you were awake, or only in dreams?) [Exclude if memories occurred only during dreams] a. How often have you had these memories in the past week? Never 0 38 b. How often have you had these memories in the past month? Never 0 39 c. How often have you had these memories in your lifetime? Never 0 40 CAPS, Part 2 v1.1 05/17/2004 Page 5

11 d. Description/Examples: How much distress or discomfort did these memories cause you? Were you able to put them out of your mind and think about something else? (How hard did you have to try?) a. How much did they interfere with your life in the past week? None 0 42 Mild, minimal distress or disruption of activities 1 Moderate, distress clearly present but still manageable, some disruption of activities 2 Severe, considerable distress, difficulty dismissing memories, marked disruption of activities 3 Extreme, incapacitating distress, cannot dismiss memories, unable to continue activities 4 b. How much did they interfere with your life in the past month? None 0 43 Mild, minimal distress or disruption of activities 1 Moderate, distress clearly present but still manageable, some disruption of activities 2 Severe, considerable distress, difficulty dismissing memories, marked disruption of activities 3 Extreme, incapacitating distress, cannot dismiss memories, unable to continue activities 4 c. How much did they interfere with your life in your lifetime? None 0 44 Mild, minimal distress or disruption of activities 1 Moderate, distress clearly present but still manageable, some disruption of activities 2 Severe, considerable distress, difficulty dismissing memories, marked disruption of activities 3 Extreme, incapacitating distress, cannot dismiss memories, unable to continue activities 4 CAPS, Part 2 v1.1 05/17/2004 Page 6

12 d. Specify: 22. Symptoms in the last month? 23. Symptoms in lifetime? (B2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content. 24. Have you ever had unpleasant dreams about (EVENT)? Describe a typical dream. (What happens in them?) a. How often have you had these dreams in the past week? Never 0 48 b. How often have you had these dreams in the past month? Never 0 49 c. How often have you had these dreams in your lifetime? Never 0 d. Description/Examples: How much distress or discomfort did these dreams cause you? Did they ever wake you up? [If YES:] (What happened when you woke up? How long did it take you to get back to sleep?) [Listen for report of anxious arousal, yelling, acting out the nightmare] (Did your dreams ever affect anyone else? How so?) CAPS, Part 2 v1.1 05/17/2004 Page 7

13 a. How much distress or discomfort did they cause you in the past week? None 0 Mild, minimal distress, may not have awoken 1 Moderate, awoke in distress but readily returned to sleep 2 Severe, considerable distress, difficulty returning to sleep 3 Extreme, incapacitating distress, did not return to sleep 4 b. How much distress or discomfort did they cause you in the past month? None 0 Mild, minimal distress, may not have awoken 1 Moderate, awoke in distress but readily returned to sleep 2 Severe, considerable distress, difficulty returning to sleep 3 Extreme, incapacitating distress, did not return to sleep 4 c. How much distress or discomfort did they cause you in your lifetime? None 0 Mild, minimal distress, may not have awoken 1 Moderate, awoke in distress but readily returned to sleep 2 Severe, considerable distress, difficulty returning to sleep 3 Extreme, incapacitating distress, did not return to sleep 4 d. Specify: Symptoms in the last month? 27. Symptoms in lifetime? (B3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur. 28. Have you ever suddenly acted or felt as if (EVENT) were happening again? (Have you ever had flashbacks about [EVENT]?) [If not clear:] (Did this ever occur while you were awake or only in dreams?) [Exclude if occurred only during dreams] Tell me more about that. a. How often has that happened in the past week? Never 0 CAPS, Part 2 v1.1 05/17/2004 Page 8 58

14 b. How often has that happened in the past month? Never 0 59 c. How often has that happened in your lifetime? Never 0 d. Description/Examples: 29. How much did it seem as if (EVENT) were happening again? (Were you confused about where you actually were or what you were doing at the time?) How long did it last? What did you do while this was happening? (Did other people notice your behavior? What did they say?) a. How much did it seem like it was happening again in the past week? No reliving 0 62 Mild, somewhat more realistic than just thinking about event 1 Moderate, definite but transient dissociative quality, still very aware of surroundings, daydreaming quality 2 Severe, strongly dissociative (reports images, sounds, or smells) but retained some awareness of surroundings 3 Extreme, complete dissociation (flashback), no awareness of surroundings, may be unresponsive, possible amnesia for the episode (blackout) 4 b. How much did it seem like it was happening again in the past month? No reliving 0 63 Mild, somewhat more realistic than just thinking about event 1 Moderate, definite but transient dissociative quality, still very aware of surroundings, daydreaming quality 2 Severe, strongly dissociative (reports images, sounds, or smells) but retained some awareness of surroundings 3 Extreme, complete dissociation (flashback), no awareness of surroundings, may be unresponsive, possible amnesia for the episode (blackout) 4 CAPS, Part 2 v1.1 05/17/2004 Page 9

15 c. How much did it seem like it was happening again in your lifetime? No reliving 0 64 Mild, somewhat more realistic than just thinking about event 1 Moderate, definite but transient dissociative quality, still very aware of surroundings, daydreaming quality 2 Severe, strongly dissociative (reports images, sounds, or smells) but retained some awareness of surroundings 3 Extreme, complete dissociation (flashback), no awareness of surroundings, may be unresponsive, possible amnesia for the episode (blackout) 4 d. Specify: 30. Symptoms in the last month? 31. Symptoms in lifetime? (B4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event 32. Have you ever gotten emotionally upset when something reminded you of (EVENT)? (Has anything ever triggered bad feelings related to [EVENT]?) What kinds of reminders made you upset? a. How often did this happen the past week? Never 0 68 b. How often did this happen in the past month? Never 0 69 CAPS, Part 2 v1.1 05/17/2004 Page 10

16 c. How often did this happen in your lifetime? Never 0 d. Description/Examples: How much distress or discomfort did (REMINDERS) cause you? How long did it last? a. How much did it interfere with your life in the past week? None 0 Mild, minimal distress or disruption of activities 1 Moderate, distress clearly present but still manageable, some disruption of activities 2 Severe, considerable distress, marked disruption of activities 3 Extreme, incapacitating distress, unable to continue activities 4 b. How much did it interfere with your life in the past month? None 0 Mild, minimal distress or disruption of activities 1 Moderate, distress clearly present but still manageable, some disruption of activities 2 Severe, considerable distress, marked disruption of activities 3 Extreme, incapacitating distress, unable to continue activities 4 c. How much did it interfere with your life in your lifetime? None 0 Mild, minimal distress or disruption of activities 1 Moderate, distress clearly present but still manageable, some disruption of activities 2 Severe, considerable distress, marked disruption of activities 3 Extreme, incapacitating distress, unable to continue activities d. Specify: Symptoms in the last month? 35. Symptoms in lifetime? CAPS, Part 2 v1.1 05/17/2004 Page 11

17 (B5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event 36. Have you ever had any physical reactions when something reminded you of (EVENT)? (Did your body ever react in some way when something reminded you of [EVENT]?) Can you give me some examples? (Did your heart race or did your breathing change? What about sweating or feeling really tense or shaky?) What kinds of reminders triggered these reactions? a. How often has this happened in the past week? Never 0 78 b. How often has this happened in the past month? Never 0 79 c. How often has this happened in your lifetime? Never 0 d. Description/Examples: How strong were (PHYSICAL REACTIONS)? How long did they last? (Did they last even after you were out of the situation?) a. How strong were the physical reactions in the past week? No physical reactivity 0 82 Mild, minimal reactivity 1 Moderate, physical reactivity clearly present, may be sustained if exposure continues 2 Severe, marked physical reactivity, sustained throughout exposure 3 Extreme, dramatic physical reactivity, sustained arousal even after exposure has ended 4 CAPS, Part 2 v1.1 05/17/2004 Page 12

18 b. How strong were the physical reactions in the past month? No physical reactivity 0 Mild, minimal reactivity 1 83 Moderate, physical reactivity clearly present, may be sustained if exposure continues 2 Severe, marked physical reactivity, sustained throughout exposure 3 Extreme, dramatic physical reactivity, sustained arousal even after exposure has ended 4 c. How strong were the physical reactions in your lifetime? No physical reactivity 0 Mild, minimal reactivity 1 84 Moderate, physical reactivity clearly present, may be sustained if exposure continues 2 Severe, marked physical reactivity, sustained throughout exposure 3 Extreme, dramatic physical reactivity, sustained arousal even after exposure has ended 4 d. Specify: 38. Symptoms in the last month? 39. Symptoms in lifetime? C. CRITERION C: CRITERION C: Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by three (or more) of the following: (C1) efforts to avoid thoughts or conversations associated with the trauma CAPS, Part 2 v1.1 05/17/2004 Page 13

19 40. Have you ever tried to avoid thoughts or feelings about (EVENT)? (What kinds of thoughts or feelings did you try to avoid?) What about trying to avoid talking with other people about it? (Why is that?) a. How often did you try to avoid these things in the past week? Never 0 88 b. How often did you try to avoid these things in the past month? Never 0 89 c. How often did you try to avoid these things in your lifetime? Never 0 90 d. Description/Examples: How much effort did you make to avoid (THOUGHTS/FEELINGS/CONVERSATIONS)? (What kinds of things did you do? What about drinking or using medication or street drugs?) [Consider all attempts at avoidance including distraction, suppression and use of alcohol/drugs] a. How much did that interfere with your life in the past week? None 0 92 Mild, minimal effort, little or no disruption of activities 1 Moderate, some effort, avoidance definitely present, some disruption of activities 2 Severe, considerable effort, marked avoidance, marked disruption of activities, or involvement in certain activities as avoidant strategy 3 Extreme, drastic attempts at avoidance, unable to continue activities, or excessive involvement in certain activities as avoidant strategy 4 CAPS, Part 2 v1.1 05/17/2004 Page 14

20 b. How much did that interfere with your life in the past month? None 0 93 Mild, minimal effort, little or no disruption of activities 1 Moderate, some effort, avoidance definitely present, some disruption of activities 2 Severe, considerable effort, marked avoidance, marked disruption of activities, or involvement in certain activities as avoidant strategy 3 Extreme, drastic attempts at avoidance, unable to continue activities, or excessive involvement in certain activities as avoidant strategy 4 c. How much did that interfere with your life in your lifetime? None 0 94 Mild, minimal effort, little or no disruption of activities 1 Moderate, some effort, avoidance definitely present, some disruption of activities 2 Severe, considerable effort, marked avoidance, marked disruption of activities, or involvement in certain activities as avoidant strategy 3 Extreme, drastic attempts at avoidance, unable to continue activities, or excessive involvement in certain activities as avoidant strategy 4 d. Specify: Symptoms in the last month? 43. Symptoms in lifetime? (C2) efforts to avoid activities, places, or people that arouse recollections of the trauma 44. Have you ever tried to avoid certain activities, places, or people that reminded you of (EVENT)? (What kinds of things did you avoid? Why is that?) a. How often did this happen the past week? Never 0 CAPS, Part 2 v1.1 05/17/2004 Page 15 98

21 b. How often did this happen in the past month? Never 0 99 c. How often did this happen in your lifetime? Never d. Description/Examples: How much effort did you make to avoid (ACTIVITIES/PLACES/PEOPLE)? (What did you do instead?) a. How much did that interfere with your life in the past week? None Mild, minimal effort, little or no disruption of activities 1 Moderate, some effort, avoidance definitely present, some disruption of activities 2 Severe, considerable effort, marked avoidance, marked disruption of activities, or involvement in certain activities as avoidant strategy 3 Extreme, drastic attempts at avoidance, unable to continue activities, or excessive involvement in certain activities as avoidant strategy 4 b. How much did that interfere with your life in the past month? None Mild, minimal effort, little or no disruption of activities 1 Moderate, some effort, avoidance definitely present, some disruption of activities 2 Severe, considerable effort, marked avoidance, marked disruption of activities, or involvement in certain activities as avoidant strategy 3 Extreme, drastic attempts at avoidance, unable to continue activities, or excessive involvement in certain activities as avoidant strategy 4 CAPS, Part 2 v1.1 05/17/2004 Page 16

22 c. How much did that interfere with your life in your lifetime? None Mild, minimal effort, little or no disruption of activities 1 Moderate, some effort, avoidance definitely present, some disruption of activities 2 Severe, considerable effort, marked avoidance, marked disruption of activities, or involvement in certain activities as avoidant strategy 3 Extreme, drastic attempts at avoidance, unable to continue activities, or excessive involvement in certain activities as avoidant strategy 4 d. Specify: 46. Symptoms in the last month? 47. Symptoms in lifetime? (C3) inability to recall an important aspect of the trauma 48. Have you had difficulty remembering some important parts of (EVENT)? Tell me more about that. (Do you feel you should be able to remember these things? Why do you think you can t?) How much of the important parts of (EVENT) have you had difficulty remembering? (What parts do you still remember?) a. How much have you had difficulty remembering in the past week? None, clear memory 0 Few aspects not remembered (>10%) 1 Some aspects not remembered (approx 20-30%) 2 Many aspects not remembered (approx 50-60%) 3 Most or all aspects not remembered (> 80%) 4 b. How much have you had difficulty remembering in the past month? None, clear memory 0 Few aspects not remembered (>10%) 1 Some aspects not remembered (approx 20-30%) 2 Many aspects not remembered (approx 50-60%) 3 Most or all aspects not remembered (> 80%) 4 CAPS, Part 2 v1.1 05/17/2004 Page

23 c. How much have you had difficulty remembering in your lifetime? None, clear memory 0 Few aspects not remembered (>10%) 1 Some aspects not remembered (approx 20-30%) 2 Many aspects not remembered (approx 50-60%) 3 Most or all aspects not remembered (> 80%) 4 d. Description/Examples: How much difficulty did you have recalling important parts of (EVENT)? (Were you able to recall more if you tried?) a. How much difficulty did you have in the past week? None 0 Mild, minimal difficulty 1 Moderate, some difficulty, could recall with effort 2 Severe, considerable difficulty, even with effort 3 Extreme, completely unable to recall important aspects of event 4 b. How much difficulty did you have in the past month? None 0 Mild, minimal difficulty 1 Moderate, some difficulty, could recall with effort 2 Severe, considerable difficulty, even with effort 3 Extreme, completely unable to recall important aspects of event c. How much difficulty did you have in your lifetime? None 0 Mild, minimal difficulty 1 Moderate, some difficulty, could recall with effort 2 Severe, considerable difficulty, even with effort 3 Extreme, completely unable to recall important aspects of event 4 d. Specify: Symptoms in the last month? 51. Symptoms in lifetime? CAPS, Part 2 v1.1 05/17/2004 Page 18

24 (C4) markedly diminished interest or participation in significant activities 52. Have you been less interested in activities that you used to enjoy? (What kinds of things have you lost interest in? Are there some things you don t do at all anymore? Why is that?) [Exclude if no opportunity, if physically unable, or if developmentally appropriate change in preferred activities] (What kinds of things do you still enjoy doing?) When did you first start to feel that way? (After the [EVENT]?) a. How many activities have you been less interested in in the past week? None 0 Few activities (>10%) 1 Some activities (approx 20-30%) 2 Many activities (approx 50-60%) 3 Most or all activities (>80%) 4 b. How many activities have you been less interested in in the past month? None 0 Few activities (>10%) 1 Some activities (approx 20-30%) 2 Many activities (approx 50-60%) 3 Most or all activities (>80%) c. How many activities have you been less interested in in your lifetime? None 0 Few activities (>10%) 1 Some activities (approx 20-30%) 2 Many activities (approx 50-60%) 3 Most or all activities (>80%) d. Description/Examples: How strong was your loss of interest? (Would you enjoy [ACTIVITIES] once you got started?) a. How strong was your loss of interest in activities in the past week? No loss of interest 0 Mild, slight loss of interest, probably would enjoy after starting activities 1 Moderate, definite loss of interest, but still has some enjoyment of activities 2 Severe, marked loss of interest in activities 3 Extreme, complete loss of interest, no longer participant in any activities CAPS, Part 2 v1.1 05/17/2004 Page 19

25 b. How strong was your loss of interest in activities in the past month? No loss of interest 0 Mild, slight loss of interest, probably would enjoy after starting activities 1 Moderate, definite loss of interest, but still has some enjoyment of activities 2 Severe, marked loss of interest in activities 3 Extreme, complete loss of interest, no longer participant in any activities 4 c. How strong was your loss of interest in activities in your lifetime? No loss of interest 0 Mild, slight loss of interest, probably would enjoy after starting activities 1 Moderate, definite loss of interest, but still has some enjoyment of activities 2 Severe, marked loss of interest in activities 3 Extreme, complete loss of interest, no longer participant in any activities 4 d. Specify: Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely Symptoms in the last month? 56. Symptoms in lifetime? (C5) feeling of detachment or estrangement from others 57. Have you felt distant or cut off from other people? What was that like? When did you first start to feel that way? (After the [EVENT]?) a. How much of the time have you felt that way in the past week? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 CAPS, Part 2 v1.1 05/17/2004 Page

26 b. How much of the time have you felt that way in the past month? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 c. How much of the time have you felt that way in your lifetime? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 d. Description/Examples: 58. How strong were your feelings of being distant or cut off from others? (Who do you feel closest to? How many people do you feel comfortable talking with about personal things?) a. How strong was your loss of interest in activities in the past week? No feelings of detachment or estrangement Mild, may feel out of synch with others 1 Moderate, feelings of detachment clearly present, but still feels some interpersonal connection 2 Severe, marked feelings of detachment or estrangement from most people, may feel close to only 1 or 2 people 3 Extreme, feels completely detached or estranged from others, not close with anyone 4 b. How strong was your loss of interest in activities in the past month? No feelings of detachment or estrangement 0 Mild, may feel out of synch with others 1 Moderate, feelings of detachment clearly present, but still feels some interpersonal connection 2 Severe, marked feelings of detachment or estrangement from most people, may feel close to only 1 or 2 people 3 Extreme, feels completely detached or estranged from others, not close with anyone 4 CAPS, Part 2 v1.1 05/17/2004 Page

27 c. How strong was your loss of interest in activities in your lifetime? No feelings of detachment or estrangement Mild, may feel out of synch with others 1 Moderate, feelings of detachment clearly present, but still feels some interpersonal connection 2 Severe, marked feelings of detachment or estrangement from most people, may feel close to only 1 or 2 people 3 Extreme, feels completely detached or estranged from others, not close with anyone 4 d. Specify: Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely Symptoms in the last month? 61. Symptoms in lifetime? (C6) restricted range of affect (e.g., unable to have loving feelings) 62. Have there been times when you felt emotionally numb or had trouble experiencing feelings like love or happiness? What was that like? (What feelings did you have trouble experiencing?) When did you first start having trouble experiencing (EMOTIONS)? (After the [EVENT]?) a. How much of the time have you felt that way in the past week? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) CAPS, Part 2 v1.1 05/17/2004 Page 22

28 b. How much of the time have you felt that way in the past month? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 c. How much of the time have you felt that way in your lifetime? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 d. Description/Examples: How much trouble did you have experiencing (EMOTIONS)? (What kinds of feeling were you still able to experience?) [Includes observations of range of affect during interview] a. How much trouble did you have experiencing emotions in the past week? No reduction of emotional experience Mild, slight reduction of emotional experience 1 Moderate, definite reduction of emotional experience, but still able to experience most emotions 2 Severe, marked reduction of emotional experience of at least two primary emotions (e.g., love, happiness) 3 Extreme, completely lacking emotional experience 4 b. How much trouble did you have experiencing emotions in the past month? No reduction of emotional experience Mild, slight reduction of emotional experience 1 Moderate, definite reduction of emotional experience, but still able to experience most emotions 2 Severe, marked reduction of emotional experience of at least two primary emotions (e.g., love, happiness) 3 Extreme, completely lacking emotional experience 4 CAPS, Part 2 v1.1 05/17/2004 Page 23

29 c. How much trouble did you have experiencing emotions in your lifetime? No reduction of emotional experience Mild, slight reduction of emotional experience 1 Moderate, definite reduction of emotional experience, but still able to experience most emotions 2 Severe, marked reduction of emotional experience of at least two primary emotions (e.g., love, happiness) 3 Extreme, completely lacking emotional experience 4 d. Specify: 64. Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely Symptoms in the last month? 66. Symptoms in lifetime? (C7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) 67. Have there been times when you felt there is no need to plan for the future, that somehow your future will be cut short? Why is that? [Rule out realistic risks such as lifethreatening medical conditions] When did you first start to feel that way? (After the [EVENT]?) a. How much of the time have you felt that way in the past week? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) CAPS, Part 2 v1.1 05/17/2004 Page 24

30 b. How much of the time have you felt that way in the past month? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 c. How much of the time have you felt that way in your lifetime? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 d. Description/Examples: How strong was this feeling that your future will be cut short? (How long do you think you will live? How convinced are you that you will die prematurely?) a. How strong was this feeling in the past week? No sense of a foreshortened future Mild, slight sense of a foreshortened future 1 Moderate, sense of a foreshortened future definitely present, but no specific prediction about longevity 2 Severe, marked sense of a foreshortened future, may make specific prediction about longevity 3 Extreme, overwhelming sense of a foreshortened future, completely convinced of premature death 4 b. How strong was this feeling in the past month? No sense of a foreshortened future Mild, slight sense of a foreshortened future 1 Moderate, sense of a foreshortened future definitely present, but no specific prediction about longevity 2 Severe, marked sense of a foreshortened future, may make specific prediction about longevity 3 Extreme, overwhelming sense of a foreshortened future, completely convinced of premature death 4 CAPS, Part 2 v1.1 05/17/2004 Page 25

31 c. How strong was this feeling in your lifetime? No sense of a foreshortened future d. Specify: Mild, slight sense of a foreshortened future 1 Moderate, sense of a foreshortened future definitely present, but no specific prediction about longevity 2 Severe, marked sense of a foreshortened future, may make specific prediction about longevity 3 Extreme, overwhelming sense of a foreshortened future, completely convinced of premature death Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely Symptoms in the last month? 71. Symptoms in lifetime? CRITERION D: CRITERION D: Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: (D1) difficulty falling or staying asleep 72. Have you had any problems falling or staying asleep? When did you first start having problems sleeping? (After the [EVENT]?) a. How often have you had these problems in the past week? Never 0 CAPS, Part 2 v1.1 05/17/2004 Page

32 b. How often have you had these problems in the past month? Never c. How often have you had these problems in your lifetime? Never 0 d. Description/Examples: Sleep onset problems? 74. Mid-sleep awakening? 75. Early a.m. awakening? 76. Total # hours sleep/night: Desired # hours sleep/night: How much of a problem did you have with your sleep? (How long did it take you to fall asleep? How often did you wake up in the night? Did you often wake up earlier than you wanted to? How many total hours did you sleep each night?) a. How much of a problem did you have with your sleep in the past week? No sleep problems 0 Mild, slightly longer latency, or minimal difficulty staying asleep (up to 30 min. loss of sleep) 1 Moderate, definite sleep disturbance, clearly longer latency, or clear difficulty staying asleep (30-90 min. loss of sleep) 2 Severe, much longer latency, or marked difficulty staying asleep (90 min. to 3 hrs loss of sleep) 3 Extreme, very long latency, or profound difficulty staying asleep (>3 hrs loss of sleep) CAPS, Part 2 v1.1 05/17/2004 Page 27

33 b. How much of a problem did you have with your sleep in the past month? No sleep problems Mild, slightly longer latency, or minimal difficulty staying asleep (up to 30 min. loss of sleep) 1 Moderate, definite sleep disturbance, clearly longer latency, or clear difficulty staying asleep (30-90 min. loss of sleep) 2 Severe, much longer latency, or marked difficulty staying asleep (90 min. to 3 hrs loss of sleep) 3 Extreme, very long latency, or profound difficulty staying asleep (>3 hrs loss of sleep) 4 c. How much of a problem did you have with your sleep in your lifetime? No sleep problems Mild, slightly longer latency, or minimal difficulty staying asleep (up to 30 min. loss of sleep) 1 Moderate, definite sleep disturbance, clearly longer latency, or clear difficulty staying asleep (30-90 min. loss of sleep) 2 Severe, much longer latency, or marked difficulty staying asleep (90 min. to 3 hrs loss of sleep) 3 Extreme, very long latency, or profound difficulty staying asleep (>3 hrs loss of sleep) 4 d. Specify: Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely CAPS, Part 2 v1.1 05/17/2004 Page 28

34 80. Symptoms in the last month? 81. Symptoms in lifetime? (D2) irritability or outburst of anger 82. Have there been times when you felt especially irritable or showed strong feelings of anger? Can you give me some examples? When did you first start feeling that way? (After the [EVENT]?) a. How often did this happen the past week? Never 0 b. How often did this happen in the past month? Never c. How often did this happen in your lifetime? Never 0 d. Description/Examples: How strong was your anger? (How did you show it?) [If reports suppression:] (How hard was it for you to keep from showing your anger?) How long did it take you to calm down? Did your anger cause you any problems? a. How strong was your anger in the past week? No irritability or anger 0 Mild, minimal irritability, may raise voice when angry 1 Moderate, definite irritability or attempts to suppress anger, but can recover quickly 2 Severe, marked irritability or marked attempts to suppress anger, may become verbally or physically aggressive when angry 3 Extreme, pervasive anger or drastic attempts to suppress anger, may have episodes of physical violence 4 CAPS, Part 2 v1.1 05/17/2004 Page

35 b. How strong was your anger in the past month? No irritability or anger Mild, minimal irritability, may raise voice when angry 1 Moderate, definite irritability or attempts to suppress anger, but can recover quickly 2 Severe, marked irritability or marked attempts to suppress anger, may become verbally or physically aggressive when angry 3 Extreme, pervasive anger or drastic attempts to suppress anger, may have episodes of physical violence 4 c. How strong was your anger in your lifetime? No irritability or anger Mild, minimal irritability, may raise voice when angry 1 Moderate, definite irritability or attempts to suppress anger, but can recover quickly 2 Severe, marked irritability or marked attempts to suppress anger, may become verbally or physically aggressive when angry 3 Extreme, pervasive anger or drastic attempts to suppress anger, may have episodes of physical violence 4 d. Specify: Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely Symptoms in the last month? 86. Symptoms in lifetime? (D3) difficulty concentrating CAPS, Part 2 v1.1 05/17/2004 Page 30

36 87. Have you found it difficult to concentrate on what you were doing or on things going on around you? What was that like? When did you first start having trouble concentrating? (After the [EVENT]?) a. How much of the time did this happen in the past week? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 b. How much of the time did this happen in the past month? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) c. How much of the time did this happen in your lifetime? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) d. Description/Examples: How difficult was it for you to concentrate? [Include observations of concentration and attention in interview] a. How much did that interfere with your life in the past week? No difficulty with concentration 0 Mild, only slight effort needed to concentrate, little or no disruption of activities 1 Moderate, definite loss of concentration but could concentrate with effort, some disruption of activities 2 Severe, marked loss of concentration even with effort, marked disruption of activities 3 Extreme, complete inability to concentrate, unable to engage in activities 4 CAPS, Part 2 v1.1 05/17/2004 Page

37 b. How much did that interfere with your life in the past month? No difficulty with concentration Mild, only slight effort needed to concentrate, little or no disruption of activities 1 Moderate, definite loss of concentration but could concentrate with effort, some disruption of activities 2 Severe, marked loss of concentration even with effort, marked disruption of activities 3 Extreme, complete inability to concentrate, unable to engage in activities 4 c. How much did that interfere with your life in your lifetime? No difficulty with concentration Mild, only slight effort needed to concentrate, little or no disruption of activities 1 Moderate, definite loss of concentration but could concentrate with effort, some disruption of activities 2 Severe, marked loss of concentration even with effort, marked disruption of activities 3 Extreme, complete inability to concentrate, unable to engage in activities 4 d. Specify: Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely Symptoms in the last month? 91. Symptoms in lifetime? CAPS, Part 2 v1.1 05/17/2004 Page 32

38 (D4) hypervigilance 92. Have you been especially alert or watchful, even when there was no real need to be? (Have you felt as if you were constantly on guard?) Why is that? When did you first start acting that way? (After the [EVENT]?) a. How much of the time were you like this in the past week? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 b. How much of the time were you like this in the past month? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) c. How much of the time were you like this in your lifetime? None of the time 0 Very little of the time (less than 10%) 1 Some of the time (approx 20-30%) 2 Much of the time (approx 50-60%) 3 Most or all of the time (more than 80%) 4 d. Description/Examples: How hard did you try to be watchful of things going on around you? [Include observations of hypervigilance in interview] Did your (HYPERVIGILANCE) cause you any problems? a. How hard did you try to be watchful of things in the past week? No hypervigilance 0 Mild, minimal hypervigilance, slight heightening of awareness 1 Moderate, hypervigilance clearly present, watchful in public (e.g., chooses safe place to sit in a restaurant or movie theatre) 2 Severe, marked hypervigilance, very alert, scans environment for danger, exaggerated concern for safety of self/family/home) 3 Extreme, excessive hypervigilance, efforts to ensure safety consume significant time and energy and may involve extensive safety/ checking behaviors, marked watchfulness during interview 4 CAPS, Part 2 v1.1 05/17/2004 Page

39 b. How hard did you try to be watchful of things in the past month? No hypervigilance Mild, minimal hypervigilance, slight heightening of awareness 1 Moderate, hypervigilance clearly present, watchful in public (e.g., chooses safe place to sit in a restaurant or movie theatre) 2 Severe, marked hypervigilance, very alert, scans environment for danger, exaggerated concern for safety of self/family/home) 3 Extreme, excessive hypervigilance, efforts to ensure safety consume significant time and energy and may involve extensive safety/ checking behaviors, marked watchfulness during interview 4 c. How hard did you try to be watchful of things in your lifetime? No hypervigilance Mild, minimal hypervigilance, slight heightening of awareness 1 Moderate, hypervigilance clearly present, watchful in public (e.g., chooses safe place to sit in a restaurant or movie theatre) 2 Severe, marked hypervigilance, very alert, scans environment for danger, exaggerated concern for safety of self/family/home) 3 Extreme, excessive hypervigilance, efforts to ensure safety consume significant time and energy and may involve extensive safety/ checking behaviors, marked watchfulness during interview 4 d. Specify: 94. Trauma-related? a. Current? Definite 1 Probable 2 Unlikely 3 b. Lifetime? Definite 1 Probable 2 Unlikely Symptoms in the last month? Symptoms in lifetime? 218 CAPS, Part 2 v1.1 05/17/2004 Page 34

40 (D5) exaggerated startle response 97. Have you had any strong startle reactions? When did that happen? (What kinds of things made you startle?) When did you first have these reactions? (After the [EVENT]?) a. How often did this happen in the past week? Never 0 b. How often did this happen in the past month? Never 0 c. How often did this happen in your lifetime? Never 0 d. Description/Examples: How strong were these startle reactions? (How strong were they compared to how most people would respond?) How long did they last? a. How strong were these reactions in the past week? No startle reaction Mild, minimal startle reaction 1 Moderate, definite startle reaction, feels jumpy 2 Severe, marked startle reaction, sustained arousal following initial reaction 3 Extreme, excessive startle reaction, overt coping behavior (e.g., combat veteran who hits the dirt) 4 b. How strong were these reactions in the past month? No startle reaction 0 Mild, minimal startle reaction 1 Moderate, definite startle reaction, feels jumpy 2 Severe, marked startle reaction, sustained arousal following initial reaction 3 Extreme, excessive startle reaction, overt coping behavior (e.g., combat veteran who hits the dirt ) 4 CAPS, Part 2 v1.1 05/17/2004 Page