Trauma Study

Steps in Completing the CAPS-5

C. Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

 The CAPS is the gold standard in PTSD assessment.

 The CAPS-5 is a 30-item structured interview that can be used to:

 Make current (past month) diagnosis of PTSD

 Make lifetime diagnosis of PTSD  Assess PTSD symptoms over the

past week  The full interview takes about 45-60

minutes to administer. 2

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 In addition to assessing the 20 DSM-5 PTSD symptoms, questions target:  the onset and duration of symptoms,  subjective distress,  impact of symptoms on social and occupational

functioning,  improvement in symptoms since a previous CAPS

administration,  overall response validity,  overall PTSD severity, and  specifications for the dissociative subtype

(depersonalization and derealization).

 For each symptom, standardized questions and probes are provided.

 Administration requires identification of an index traumatic event to serve as the basis for symptom inquiry.

 The Life Events Checklist for DSM-5 (LEC-5) is recommended in addition to the Criterion A inquiry included in the CAPS-5.

 The CAPS was designed to be administered by clinicians and clinical researchers who have a working knowledge of PTSD, but can also be administered by appropriately trained paraprofessionals.

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1. CAPS Training  To learn about giving a CAPS-5 assessment, there are

links for video training on the CAPS-5 website.  Technical manuals are also available for the DSM-IV

versions of the CAPS and CAPS-CA can be found at “Western Psychological Services” (WPS) website.

 Search their online list of available products for CAPS (which includes the CAPS-CA).

 Interview booklets, interview guides, and a technical manual are available for the CAPS and CAPS-CA.

 To obtain the CAPS-5, at the website, click on the link at the bottom and complete the online form.

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Important Links: • CAPS-5 webpage:

https://www.ptsd.va.gov/professional/assessment/ adult-int/caps.asp

• CAPS-5 training: https://www.ptsd.va.gov/professional/continuing_ ed/caps5_clinician_training.asp

• To obtain permission to get a copy of the scale: https://www.ptsd.va.gov/professional/assessment/ ncptsd-instrument-request-form.asp

2. Scoring

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 Detailed scoring information is included with the CAPS-5 and should be reviewed carefully before administering.

 The assessor combines information about frequency and intensity of an item into a single severity rating, which is calculated by summing severity scores for the 20 DSM-5 PTSD symptoms.

 Similarly, CAPS-5 symptom cluster severity scores are calculated by summing the individual item severity scores for symptoms corresponding to a given DSM-5 cluster: Criterion B (items 1-5); Criterion C (items 6-7); Criterion D (items 8- 14); and, Criterion E (items 15-20).

 A symptom cluster score may also be calculated for dissociation by summing items 19 and 20.

 To receive a PTSD diagnosis, the client must meet:  At least one Criterion B symptom (Intrusion)  At least one Criterion C symptom (Avoidance)  At least two Criterion D symptoms (Negative Thinking/Feeling)  At least two Criterion E symptoms (Arousal/Reactivity)  Criterion F is met (disturbance has lasted One Month)  Criterion G is met (disturbance causes either/both Clinically

Significant Distress or Functional Impairment)

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3. Severity Rating

0. Absent: The respondent denied the problem or the respondent's report doesn't fit the DSM-5 symptom criterion.

1. Mild / subthreshold: The respondent described a problem that is consistent with the symptom criterion but isn't severe enough to be considered clinically significant. The problem doesn't satisfy the DSM-5 symptom criterion and thus doesn't count toward a PTSD diagnosis.

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2. Moderate / threshold: The respondent described a clinically significant problem. The problem satisfies the DSM-5 symptom criterion and thus counts toward a PTSD diagnosis. The problem would be a target for intervention. This rating requires a minimum frequency of 2 x month or some of the time (20- 30%) PLUS a minimum intensity of Clearly Present.

3. Severe / markedly elevated: The respondent described a problem that is above threshold. The problem is difficult to manage and at times overwhelming, and would be a prominent target for intervention. This rating requires a minimum frequency of 2 x week or much of the time (50-60%) PLUS a minimum intensity of Pronounced.

4. Extreme / incapacitating: The respondent described a dramatic symptom, far above threshold. The problem is pervasive, unmanageable, and overwhelming, and would be a high-priority target for intervention.

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Criteria for DSM-5 listed Questions to help guide the

interview A place to record the

“index” event Comment box for client’s

responses (try to always get client’s actual words)

Checklist for exposure type Three choices of traumatic

event type Is criteria A met? Yes?

No? Maybe so? 11

4. Let’s Look at the parts:

Rest of the criteria/pages are similar to this:

Criteria for DSM-5 listed Questions to help guide the

interview (try to always get client’s actual words)

Client’s severity rating Circle the level of distress

they are having Number of times in the

past month Key explanations for rating

a client with moderate and severe intensity/ distress

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5. Criterion F, G, and “Global Rating”

 Items 21 and 22 look at Criterion F – making sure the duration if the disturbance is at least or more than one month.

 Criterion G – does the disturbance cause clinically significant distress across:  #23: Subjective areas  #24: Social areas  #25: Occupational/

Other areas

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 Item 26 looks at the validity of the client’s responses; Are they accurate? Are there other factors involved that decrease accuracy?

 Item 27: based on your opinion after doing the CAPS-5, rate the severity of their PTSD symptoms.

 Item 28: has there been any improvement for the client over the past month? 14

6. Depersonalization & Derealization  The CAPS-5 looks for

possible Dissociative symptoms that can occur from trauma.

 “Depersonalization” looks for clients who feel like they are:  “detached” from

themselves  an outside observer  like they are in a dream  feeling as if things are

“unreal”  time is moving slowly

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 “Derealization” looks for clients who feel like the world around them is experienced as:  unreal  dream-like  distant  distorted  feels like they are in

a “movie”

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7. Summarizing Scoring is very simple;

transfer items from each page that matches the

correct item and section: 1. Is Criteria A met? (if

“No,” consider ASD or Adjustment D/O)

2. The severity scores (0-4) 3. Total sum of severity 4. Is the severity above 2?

Circle 1 = Yes if so. 5. Total number of “Yeses”

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 Add up “Total Severity” and “Total Symptoms” from Criterion B, C, D, E)

 Circle for Criteria F: “Has the current duration of the disturbance been a month or longer?” (if “No,” consider ASD or Adjustment D/O)

 Add and total up the severity and symptoms for Criteria G.

 Place the numbers for the three “Global Ratings.”

 Place and total the severity and symptoms for any “Dissociative Symptoms.”

 Make your Diagnostic Impression based on the data.

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