In a couple of my previous videos I went through the diagnostic criteria for PTSD and Complex PTSD. And this diagnostic criteria is obviously something that an appropriate healthcare or medical professional will use to make a decision of diagnosis. One way, and arguably the best west, to do this is to assess through clinical interview. In other words you will explain your experience to a professional and they will map your experience onto the diagnostic criteria.
We also have another tool available to us, which can be helpful in the assessment process, and that is through questionnaire.
One of the most common questionnaires, and the one used in NHS talking therapy services is called the PCL-5, which stands for the PTSD check list. This is a 20 question self report measure that assesses the 20 symptoms listen in the DSM5 for PTSD. So basically its a questionnaire that mirrors the DSM5.
And questionnaires can be really helpful. They can act as a screening tool to decide whether further investigation into PTSD is appropriate. They can be used to make a provisional or working diagnosis, and they can be used to monitor symptom change during and after any treatment so we can see if that treatment is working or not.
Just as an aside here, where I live and work in England, if you use a questionnaire without a clinical interview, and you score above the threshold on that questionnaire, then you should be treated the same as if you had a clinical interview. NICE guidance, so thats national institute for health and social care excellence, who offers guidance for treatment, refers to this as clinical important symptoms.
They say, people with clinically important symptoms of PTSD refer to those who are assessed as having PTSD on a validated scale (which the PCL 5 is), as indicated by baseline scores above the clinical threshold, but who do not necessarily have a diagnosis of PTSD. They are typically referred to in studies that have not used a clinical interview to arrive at a formal diagnosis of PTSD and instead have only used self-report measures of PTSD symptoms.
So that talks about how they are referred to in studies, but if we look at the actual guidance from NICE for treatment it refers to people who have a formal diagnosis and people who have clinically important symptoms. Here are a couple of examples on screen.
So lets take a look at the PCL-5.
There is a good webiste called onlinecbtresources.co.uk which has a load of questionnaires to fill out on line. I am not affiliated with them in anyway, I have no idea who runs that website, but what i do know is that there are a lot of websites where you fill out the questionnaire and then before it gives you a score it asks for your email address, and they email it to you, because they want to harvest your data. I hate that. This website, doesnt do that, you fill out the form and it gives you the result.
Lets take a look.
Down here we have a list of problems, and theres 20 of them. And these problems should be a response to a stressful, or traumatic experience. If youve watched my video on the criteria for PTSD then this event or experience is what we referred to as criteria A in that video.
And what we think about is how often have you been bothered by the problem in the last week. So please remember, this it is how often you have been bothered, not how often you have experienced it. I’ll explain more about that in a bit.
And the options you have are not at all, so it hasnt bothered me at all. its bothered me a little bit, its bothered me moderately, its bothered me quite a bit, and its bothered me extremely. Not at all scores a 0, and extremely scores a 4, with the other points in between as you would expect.
Now these terms, a little bit, moderately, quite a bit and extremely don’t have definitions, its subjective and up to you to decide what they mean to you.
The first one here, in the last week, how bothered have you been by having repeated, disturbing, and unwanted memories of the stressful experience? So if you have experienced no repeated, disturbing an unwanted memories then you would select not at all. If, and I dont know how likely this is, but this is to explain the point about being bothered. if you have repeated, disturbing and unwanted memories every day of the week, but for some reason they didnt bother you, then again you would select not at all. If you do have these type of memories, and they do bother you then you are going to have decide to what degree they bother you. is it a little bit, is it moderately, is quite a bit or is it extremely?
Question 2 same again, but this time its asking about disturbing dreams, so you would probably want to consider how many nights of the week you are having them, and when you do have them, how long do they keep you up for, do you actually go back to bed or to sleep, maybe you wake up realise it was a dream and then full straight back asleep again. Maybe you dont have dreams at all about the event. Everyones experience is different.
So you work your way down the questionnaire and answer all 20 questions. And when you are done you press this total button and it gives you a number.
The lowest score you can get is 0 and the highest score is 80.
Generally speaking, and this includes where I work, a total score of 32 or over, would indicate symptoms of PTSD and that someone may benefit from PTSD treatment.
There are other ways to interpret the results but total score is the easiest way if you aren’t a clinician. As the questionnaire is based upon the DSM5 criteria then you can work out from this more precisely which criteria cluster is met and to what extent, but for the purpose of this video, and the audience who are likely to watch it, the total score is good enough.
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