TTC Assessment and Diagnosis of Trauma 2 — Questions and Answers
Question 1: Which instrument is specifically designed to assess complex PTSD and distinguishes it from simple PTSD by measuring disturbances in self-organization?
- PCL-5
- ITQ (International Trauma Questionnaire) (Correct answer)
- CAPS-5
- TSC-40
Correct answer: ITQ (International Trauma Questionnaire)
The ITQ was developed to assess both PTSD and Complex PTSD (ICD-11) and includes subscales for disturbances in affect regulation, self-concept, and relational disturbances.
Question 2: During a trauma assessment, a client dissociates and becomes unresponsive mid-session. The FIRST priority of the clinician should be:
- Complete the trauma history to avoid retraumatization from stopping
- Use grounding techniques to help the client return to the present (Correct answer)
- Immediately refer the client to an inpatient facility
- Document the dissociative episode and reschedule
Correct answer: Use grounding techniques to help the client return to the present
Grounding techniques (e.g., 5-4-3-2-1 sensory anchoring) help re-orient the client to the present moment and restore window of tolerance before continuing.
Question 3: Which of the following best describes 'criterion A' in DSM-5 PTSD diagnosis?
- Exposure to actual or threatened death, serious injury, or sexual violence (Correct answer)
- Presence of at least two negative alterations in cognition and mood
- Re-experiencing the trauma through intrusive memories or flashbacks
- Marked physiological reactions to trauma-related cues
Correct answer: Exposure to actual or threatened death, serious injury, or sexual violence
Criterion A specifies that the individual must have been exposed to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, learning it happened to a close other, or repeated exposure.
Question 4: A veteran reports hypervigilance, sleep disturbance, and emotional numbing but denies having intrusive memories or nightmares. Which DSM-5 PTSD specifier might BEST capture this presentation?
- PTSD with dissociative symptoms
- PTSD with delayed expression (Correct answer)
- Subthreshold PTSD
- Acute stress disorder
Correct answer: PTSD with delayed expression
The 'with delayed expression' specifier applies when full diagnostic criteria are not met until at least 6 months after the event, though some symptoms may appear earlier.
Question 5: The Adverse Childhood Experiences (ACE) Study found that higher ACE scores correlate most directly with:
- A lower likelihood of developing anxiety disorders in adulthood
- Increased risk of chronic disease, mental illness, and early death (Correct answer)
- Greater resilience and post-traumatic growth in survivors
- Reduced sensitivity to stress hormones in the HPA axis
Correct answer: Increased risk of chronic disease, mental illness, and early death
The ACE Study demonstrated a dose-response relationship: higher ACE scores predict significantly elevated risk for depression, substance abuse, cardiovascular disease, cancer, and premature death.
Question 6: In trauma assessment, 'peritraumatic dissociation' refers to dissociation that occurs:
- Years after the traumatic event during therapy
- During or immediately after the traumatic event (Correct answer)
- Only in individuals with a prior dissociative disorder
- As a side effect of trauma-focused psychotherapy
Correct answer: During or immediately after the traumatic event
Peritraumatic dissociation—dissociation occurring during or immediately after the trauma—is one of the strongest predictors of later PTSD development.
Question 7: When assessing a child for trauma using the UCLA PTSD Reaction Index, a clinician should be aware that this tool:
- Is only validated for children aged 12 and above
- Can be used as a clinician-administered or self-report measure and assesses DSM criteria (Correct answer)
- Excludes complex trauma presentations and focuses only on single-incident events
- Provides a categorical PTSD diagnosis without symptom severity scoring
Correct answer: Can be used as a clinician-administered or self-report measure and assesses DSM criteria
The UCLA PTSD Reaction Index is a widely used, DSM-aligned measure available in clinician-administered and self-report formats for children and adolescents.
TTC Assessment and Diagnosis of Trauma 2
Which instrument is specifically designed to assess complex PTSD and distinguishes it from simple PTSD by measuring disturbances in self-organization?