How PTSD Screenings Work

For those who feel they might be suffering from post-traumatic stress disorder (PTSD), the first step toward a healthier life is admitting there may be a problem. The second step is to get help. That is where the PTSD screening comes in for further evaluation.

Post-traumatic stress disorder has symptoms that may also apply to other mental health issues or other medical conditions. A screening process is necessary to determine the real problem, the extent of the patient’s needs, and how best to approach treatment.

A PTSD screening can take the form of a written questionnaire, a Q&A with a professional, or both. In many cases there will be a preliminary screening and follow-up work depending on the nature and severity of the symptoms.

In others, a mental health professional may identify certain characteristics or behaviors that point specifically to one condition or another which may also coincide with a PTSD diagnosis.

You read that correctly, PTSD can be a factor even when a patient has been diagnosed with a different condition. Some sources indicate as many as 80 percent of the population of PTSD sufferers will experience a “co-occurring disorder” at some point.

Some patients who experience a pre-existing mental health condition are also likely candidates to be PTSD sufferers, too. This is true of many conditions, but especially bipolar disorder, major depressive disorder, and substance abuse problems.

Getting to A PTSD Screening with A Self-Assessment

Those who worry that they may have post-traumatic stress disorder have either started a self-assessment or should begin one. A good way to make some early progress towards a diagnosis and treatment is to take a PTSD assessment test online.

One such PTSD assessment is available from the Department of Veterans Affairs official site via the MyHealtheVet site. It’s a 17-question form (also available in a non javascript, text-only version for slower connections) that is completed and processed entirely on the user’s computer. No information is stored as a result of using this self-assessment.

The questions are intended to help the user rate the severity of PTSD symptoms. One question from the MyHealtheVet site asks the user to rate, “Having physical reactions (e.g., heart pounding, trouble breathing, sweating) when something reminded you of a stressful military experience?” on a scale from “not at all” to “extremely.”

Use The Screening Even If You Already Believe You Need Help with PTSD

You may already be aware of the nature, severity, and duration of PTSD symptoms in your own (or your loved one) case. These screenings are important because they give a more quantifiable set of answers you can use and refer to when seeing a health professional. Questionnaires like these are also useful because you may not realize certain aspects of PTSD are manifesting themselves in specific ways.

The MyHealtheVet PTSD assessment rates the answers with points (one point for “not at all” answers, all the way to five points for “extremely” answers) in ranges between 0 and 20 (no or few PTSD symptoms), 21-29 (“minimal” symptoms), and 30-85 (“many symptoms”).

In any case no matter what your score range might be, if you are troubled by PTSD symptoms it is crucial to talk to a professional. Your symptoms may be related to PTSD, some other condition, or the symptoms may be in the earliest stages of manifesting themselves.

Self-diagnosis is never a good idea, while self-assessment is an important tool that can help you get the care you need.

When You Make an Appointment to Be Formally Evaluated

It may be a very good idea to print or screen capture your PTSD assessment and bring it with you to your first appointment to be screened on a formal basis. It’s entirely likely your doctor will administer a new screening or follow up on your answers for the first one to see if your feelings about the answers are the same or if they have changed.

Remember, only trained professionals are able to administer a complete assessment. They can diagnose you with PTSD or tell when the symptoms are not related to a different condition.

The official site of the Anxiety and Depression Association of America reminds us, “Research has recently shown that PTSD among military personnel may be a physical brain injury, specifically of damaged tissue, caused by blasts during combat.” It’s true. Some aspects of mental health may be related to physical problems that have nothing to do with trauma, but PTSD may be co-occurring in such cases depending on circumstances.

Resources Your Doctor May Use To Screen You

There are many diagnostic tools professionals use to help screen patients for PTSD symptoms. One is the DSM reference manual (the current edition at the time of this writing is the DSM-V) which contains the accepted diagnoses and conditions related to mental health issues including post-traumatic stress disorder.

Another tool is known as the “Structured Clinical Interview for DSM (SCID)” which is described as a “semi-structured interview for making the major DSM-5 diagnoses” including PTSD.

This clinical interview is only intended to be administered by a trained mental health professional. Some may feel intimidated by such diagnostic tools, but Structured Clinical Interviews are coded as “present,” “subthreshold,” or “absent” rather than providing value judgments or numerical scoring of symptoms. This interview tool may last only a few minutes, but can run much longer if the patient’s needs require it.

Another medical tool is known as the “TOP- 8” or Treatment Outcome Post Traumatic Stress Disorder Scale. A brief interview-based assessment of the DSM-IV version of PTSD.

The interview questions/topics are informed by three “symptom clusters” for PTSD which include re-experiencing trauma, avoidance of things that create uncomfortable feelings or memories associated with the trauma, “numbing,” and “hyperarousal.”

What Formal PTSD Screenings Are Designed To Do

A formal PTSD screening is intended to identify problems and help the professional arrive at an initial conclusion for possible further development or treatment. If your symptoms are severe, your doctor may recommend a different course of action than if your symptoms are minor. But in any case, you should make a point to discuss any symptom that is causing you difficulty in your everyday life no matter what it might be.

Your initial screening is unlikely to be the last word on the subject, but it’s a good place for your doctor to begin the conversation about what to do next.

PTSD screenings are not intended to be the sole determining factor as to whether or not you need hospital treatment, long-term medication, or other measures. It’s the beginning of care and not the care itself. Some people may require both supervised or managed care and long-term medication. These are the results of detailed consultation with a professional, not the result of using a single diagnostic tool such as a TOP-8 or SCID.

What The Department of Veterans Affairs Says About PTSD Screening Tools

All patients should know that there is no single “magic bullet” screening or treatment for PTSD. The best tool to screen for PTSD depends in part on the outcome goals of the screening. There are some things your doctor will consider before choosing the right diagnostic tools, screenings, etc. including (as described on the VA official site):

• Time required to administer the measure
• Reading level of the population being sampled
• Determining whether the symptoms are related to a single traumatic event or to assess symptoms related to multiple traumatic events
• Whether the measure needs to correspond to DSM criteria for PTSD
• Psychometric strengths and weaknesses of the measure
• Whether complexity and language of the measure is appropriate to the population being sampled.

The VA advises that diagnosing PTSD may be most effective when the doctor conducts a formal interview in the right circumstances. Do not be surprised if your healthcare provider forgoes an on-paper type assessment in favor of simply asking you a group of questions and following up on your answers.

An Important PTSD Caveat

 The PTSD experience is not a universal one. Post-traumatic stress disorder can occur from a single event or a group of events. It is important to avoid generalization of the symptoms and treatment of PTSD or treat the condition’s diagnosis as a “standard prognosis.” Every case is different, every cause is different, and each treatment pathway will succeed or fail depending on individual circumstances.

Who Can Help Screen You for Post-Traumatic Stress Disorder?

It can be difficult to know where to begin when it’s time to seek out a formal screening or evaluation of PTSD. You may seek the help of a trained counselor, psychologist, therapist, psychiatrist, or other professional. But the title of your provider or screener isn’t as important as their experience.

The Department of Veterans Affairs official site reminds veterans and their families to make sure their caregiver has experience treating patients suffering from trauma, but there are other areas to pay attention to:

• • It is best to seek out a care provider with experience with “evidence-based medications” or proven psychotherapy approaches for PTSD such as cognitive behavioral therapy, prolonged exposure therapy, or Cognitive Processing therapy.
  • Ask your potential care provider what insurance is accepted for those services and ask how much you may be required to pay yourself.
  • Consider asking your primary care doctor for a referral to a trusted colleague.
  • Contact your insurance company to see which mental healthcare providers are in your network and what your insurance will pay for with these providers. You may be required by your insurance company to try a specified mental health professional first.

Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News