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Clinician Administered PTSD Scale

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The Clinically Administered PTSD Scale (CAPS) is an in-person clinical assessment for measuring posttraumatic stress disorder (PTSD).Cite error: A <ref> tag is missing the closing </ref> (see the help page). Previous measures of PTSD typically included introspective (subjective) self-report measures that the patient fills out without the help of a clinician. The clinically-administered PTSD scale was modeled after the Hamilton Depression Scale (HDRS),[1] a clinician-administered scale to assess depressive features. It should be noted however that the HDRS has been subject to criticism.[2]

Some important features of the CAPS are:

  1. Allows for a range of symptom severity rather than a dichotomous (yes/no) result. This allows for both a diagnosis as well as a sliding scale for clinicians to assess relative changes. It can be used for weekly changes or for a one-time diagnosis.
  2. Creation of two scales: frequency and severity of symptoms. To fulfill a symptom criteria, a patient needs to have a certain frequency and severity of symptoms. This allows for a more refined level of measurement by measuring both how often a patient has symptoms and how severe they are.[3]
  3. Uniformity - the assessment was created in a way that would promote uniform administration of the assessment through clear questions and probes for interviewers.[1]

Evolution

Table 1 – Versions of the CAPS by Diagnostic Statistical Manual version[4][1]

DSM-III-R (1987) DSM-IV (1994) DSM-5 (2013)
Past month CAPS-1 CAPS-DX CAPS-5
Past week CAPS-2 CAPS-SX CAPS-5
Worst month

(lifetime)

CAPS-1 CAPS-DX CAPS-5
Children . CAPS-CA CAPS-CA-5

The CAPS has developed over the years to keep up with changes in the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is currently in its fifth edition (DSM-5, May 2013) and serves as a guide to clinicians in diagnosing mental disorders.[5] It should be noted, however, that the DSM system of psychiatric classifications is problematic in typecasting many relatively normal behavioral issues as "abnormal" (e.g., such as the over-classification of ADHD), promoting and entrenching archaic stereotypical psychiatric nosology, and in reifying subjective suppositions about psychopathology.[6] Detailed critiques of the DSM system of psychiatric classifications have been published.[7][8]

Currently, there are three versions of the CAPS-5 (Table 1). One version provides responses in the past month, one provides responses in the past week, and the last provides responses for the worst month (lifetime PTSD). There is also a version for children - the CAPS-CA-5[9] Table 1 also shows the development of the CAPS by DSM version.

The CAPS1 was intended to monitor changes over a one-month period, whereas the CAPS-2 was developed to monitor changes over a week period. The CAPS-1 and CAPS-2 were later changed to the CAPS-DX and CAPS-SX respectively to avoid confusion over future versions. The CAPS-5 has two versions – one that can assess for one-week changes and one that can assess for one-month changes.[1] The one-week changes may be more helpful for treatment providers to see change in symptom scores over time, whereas the one-month changes may be more helpful to assess for baseline PTSD.

The CAPS has been revised to the CAPS-5 to reflect current changes in the DSM-5. The CAPS is currently the gold-standard assessment for PTSD and is used widely through the VA for compensation and pension determinations.[10] As described in Table 1, there are three versions of the CAPS, one to monitor monthly changes (often used for diagnosis), one to monitor weekly changes (often for assessing for time changes) and worst month (to assess for lifetime PTSD).

Current version and recent changes

The current CAPS-5 contains 30 questions relating to PTSD symptoms. Each question asks about both the frequency and the severity of each symptom. These questions are split into categories. Each criterion has several questions, and scores for each criterion are added up at the end.[11]

  • Criterion A: A traumatic event
  • Criterion B: Re-experiencing symptoms
  • Criterion C: Avoidance symptoms
  • Criterion D: Negative alterations in cognitions and mood
  • Criterion E: Alterations in arousal and reactivity
  • Criterion F: Disturbance lasted at least a month
  • Criterion G: Disturbance causing impairment

Scoring

To meet criteria for PTSD, a patient must have:[9]

  • An index trauma/Criterion A event
  • At least one Criterion B symptom (questions 1-5)
  • At least one Criterion C symptom (questions 6-7)
  • At least two Criterion D symptoms (questions 8-14)
  • At least two Criterion E symptoms (questions 15-20)

Both criterion F and G must be met as well for a PTSD diagnosis.[9] To meet criteria for a symptom, a patient must meet criteria in both frequency and intensity score for each item. Frequency and intensity and then combined to form a single severity score. Severity scores range from 0-4, with 0 being absent to 4 being extreme/incapacitating.[9]

The National Center for PTSD provides information for clinicians to learn how to administer and score the CAPS. They recommend that, in addition to training, the CAPS be administered by clinicians familiar with PTSD.

Sample question and clinician follow-up

Sample Question: "In the past month, have you had any unwanted memories of (EVENT) while you were awake, so not counting dreams?")[9]

  • To calculate frequency, a patient may be asked "In the past month, have you had any unwanted memories of (EVENT) while you were awake, so not counting dreams?" or "How often have you had these memories in the past month?"[9]
  • To calculate intensity, a patient may be asked "How much do these memories bother you" and "Are you able to put them out of your mind and think about something else."[9]

These frequency and intensity scores will get calculated together to create a severity score for each question. Total symptom severity is calculated by summing up all the individual item severity scores. For example, in the CAPS-IV scoring, to meet criteria for a symptom, the symptom must have an intensity score of 2 (on a scale or 0-4) or greater and a frequency score of 1 (on a scale of 0–4) or greater.

Psychometric properties

Test-Retest Reliability: Although relatively high test-retest coefficients have been reported (Time 1 vs. Time 2), no information has been provided about the actual retest time interval.[12] It is not possible to interpret test-retest reliability coefficients in the absence of knowing the retest time interval.[13][14] Without provision of clear-cut information about the temporal stability of the CAPS-5 over varying intervals of time (e.g., 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year, 5 years, etc.), administration of the CAPS-5 cannot be recommended for assessment of PTSD in clinical populations.

Limitations

  • The CAPs can only assess for one trauma (one Criterion A event). This can present difficulties when a patient may have more than one trauma.
  • The CAPS can be a lengthy interview taking up to 45–60 minutes. It may be difficult to find the personnel and time to conduct these interviews for clinics that have less resources available.
  • The CAPS was constructed using data from military veterans. Although it is used in non-veteran populations, there may be differences in traumatology and symptoms between these populations.

References

  1. ^ a b c d Weathers; Keane; Davidson (2001). "Clinician-administered PTSD scale: A review of the first ten years of research" (PDF). Depression and Anxiety. 13 (3): 132–56. doi:10.1002/da.1029. PMID 11387733. Retrieved 2016-03-07.
  2. ^ Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004). "The Hamilton Depression Rating Scale: has the gold standard become a lead weight?". American Journal of Psychiatry. 161 (12): 2163–77. doi:10.1176/appi.ajp.161.12.2163. PMID 15569884.
  3. ^ Blake, Dudley (1994). "Rationale and development of the clinician-administered PTSD Scales" (PDF). The National Center for Post-Traumatic Stress Disorder. Retrieved 2016-03-07.
  4. ^ Cite error: The named reference :2 was invoked but never defined (see the help page).
  5. ^ American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.
  6. ^ Boyle, G.J. (2006). Scientific Analysis of Personality and Individual Differences. D.Sc. Thesis, University of Queensland, St. Lucia, Queensland. National Library of Australia catalogue entry for D.Sc. thesis. [Retrieved 6 November 2017]
  7. ^ Beutler, L.E., & Malik, M.L. (2002). Rethinking the DSM: A Psychological Perspective. Washington, DC: American Psychological Association.
  8. ^ Malik, M.L., Johannsen, B.E., & Beutler, L.E. (2008). Personality dosorders and the DSM: A critical review. In G.J. Boyle, G. Matthews, & D.H. Saklofske. (Eds.), The SAGE Handbook of Personality Theory and Assessment: Vol. 1 - Personality Theories and Models. Los Angeles, CA: Sage Publishers.
  9. ^ a b c d e f g "Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) - PTSD: National Center for PTSD". www.ptsd.va.gov. Retrieved 2016-03-08.
  10. ^ Department of Veterans Affairs. "Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension Examinations" (PDF). Veterans Affairs Brief. Retrieved 2016-03-09.
  11. ^ "PTSD Fact Sheet" (PDF). Post-Traumatic Stress Disorder. American Psychiatric Association. 2013. Retrieved 2016-03-07.
  12. ^ Weathers, F.W., Bovin, M.J., Lee, D.J., Sloan, D.M., Schnurr, P.P., Kaloupek, D.G., Keane, T.M., & Marx, B.P. (2017, May 11). The clinician-administered PTSD scale for DSM-5 (CAPS-5). Development and initial psychometric evaluation in military veterans. Psychological Assessment, May 11. Advance online publication. doi.org/10.1037/pas0000486
  13. ^ Boyle, G.J. (1985). Self report measures of depression: Some psychometric considerations. British Journal of Clinical Psychology, 24, 45-59.
  14. ^ Boyle, G.J., Saklofske, D.H., Matthews, G. (2015). Criteria for selection and evaluation of scales/measures. In G.J. Boyle et al. (Eds.), Measures of Personality and Social Psychological Constructs. San Diego, CA: Elsevier/Academic Press.
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