What is the recommended approach to assess for Post-Traumatic Stress Disorder (PTSD)?

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Last updated: June 11, 2025 • View editorial policy

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From the Guidelines

The recommended approach to assess for Post-Traumatic Stress Disorder (PTSD) involves a comprehensive clinical evaluation using validated screening tools and diagnostic interviews, as outlined in the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1.

Key Components of Assessment

  • Clinicians should begin with standardized screening instruments such as the PTSD Checklist for DSM-5 (PCL-5), Primary Care PTSD Screen (PC-PTSD), or Impact of Event Scale-Revised (IES-R) to identify potential cases.
  • Following a positive screen, a thorough diagnostic interview should be conducted using structured or semi-structured formats like the Clinician-Administered PTSD Scale (CAPS-5), considered the gold standard for PTSD diagnosis.
  • The assessment should evaluate the presence of a qualifying traumatic event and the four symptom clusters: intrusion symptoms, avoidance behaviors, negative alterations in cognition and mood, and hyperarousal symptoms.

Importance of Comprehensive Evaluation

  • A comprehensive evaluation should also include assessment of functional impairment, suicide risk, and protective factors.
  • Clinicians should assess for comorbid conditions such as depression, substance use disorders, and other anxiety disorders, which frequently co-occur with PTSD.
  • This multi-method approach combining screening tools, diagnostic interviews, and clinical judgment provides the most accurate diagnosis and informs appropriate treatment planning, as supported by the evidence from the 2023 clinical practice guideline 1.

Prioritizing Recent and High-Quality Evidence

  • The most recent and highest quality study, published in 2024 in the Annals of Internal Medicine 1, provides the strongest evidence for the recommended approach to assessing PTSD.
  • This study outlines the importance of using validated screening tools and diagnostic interviews, and highlights the need for a comprehensive evaluation that includes assessment of functional impairment, suicide risk, and protective factors.

From the FDA Drug Label

The effectiveness of sertraline in the treatment of PTSD was established in two multicenter placebo-controlled studies (Studies 1-2) of adult outpatients who met DSM-III-R criteria for PTSD Study outcome was assessed by the Clinician-Administered PTSD Scale Part 2 (CAPS) which is a multi-item instrument that measures the three PTSD diagnostic symptom clusters of reexperiencing/intrusion, avoidance/numbing, and hyperarousal as well as the patient-rated Impact of Event Scale (IES) which measures intrusion and avoidance symptoms The CAPS-2 is a multi-item instrument that measures 3 aspects of PTSD with the following symptom clusters: Reexperiencing/intrusion, avoidance/numbing and hyperarousal

To assess for Post-Traumatic Stress Disorder (PTSD), the recommended approach is to use the following tools:

  • Clinician-Administered PTSD Scale Part 2 (CAPS-2): a multi-item instrument that measures the three PTSD diagnostic symptom clusters of:
    • Reexperiencing/intrusion
    • Avoidance/numbing
    • Hyperarousal
  • Impact of Event Scale (IES): a patient-rated scale that measures intrusion and avoidance symptoms These tools can help assess the severity of PTSD symptoms and monitor treatment response 2, 3.

From the Research

Assessing for PTSD

To assess for Post-Traumatic Stress Disorder (PTSD), the following steps can be taken:

  • Identify patients with anxiety or other psychiatric illnesses and assess for past trauma to aid in diagnosing and treating PTSD 4
  • Use the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision to provide diagnostic criteria 4
  • Utilize the PTSD Checklist for DSM-5 to help diagnose PTSD and determine severity 4
  • Consider the patient's symptoms, including trauma-related intrusive thoughts, avoidant behaviors, negative alterations of cognition or mood, and changes in arousal and reactivity 4

Recommended Assessment Tools

Some recommended assessment tools for PTSD include:

  • PTSD Checklist for DSM-5 4
  • Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision 4
  • Brief, evidence-based measures to screen for PTSD and monitor symptom changes over time 5

Importance of Assessment

Assessing for PTSD is crucial, as it can lead to ongoing disruption of life due to avoidance, impaired vocational and social functioning, and other symptoms if left untreated 6 Early intervention and treatment can improve clinical outcomes, and interest is growing in screening for PTSD in medical populations 6

Comorbidities and Treatment

PTSD is often complicated by comorbidity, and treatment requires a multimodal approach, usually including medication, different therapeutic techniques, and management of comorbidity 6 Pharmacologic agents and trauma-focused therapies have shown benefit in treating PTSD, but a need still remains for treatments that are more effective and efficient, with faster onset 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Posttraumatic Stress Disorder: Evaluation and Treatment.

American family physician, 2023

6
Research

Assessment and Management of Posttraumatic Stress Disorder.

Continuum (Minneapolis, Minn.), 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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