Primary Care Ptsd Screen
The Primary Care PTSD Screen was developed not as a diagnostic tool, but as an effective screening tool . This screening tool was initially validated with Veterans Affairs primary care patients, but its use has been demonstrated for nonveteran clients as well . If a client answers yes to any three of the following questions, the results of the screening should be considered positive:
In the past month, have you had an experience in your life that was so frightening, horrible, or upsetting that you:
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Had nightmares about it or thought about it when you didn’t want to?
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Tried hard not to think about it or went out of your way to avoid situations that remind you of it?
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Were constantly on guard, watchful, or easily startled?
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Felt numb or detached from others, activities, or your surroundings?
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Felt guilty or unable to stop blaming yourself or others for the event or any problems the event may have caused?
Further interviewing should be conducted to determine whether or not PTSD could be diagnosed. For a copy of the Primary Care PTSD Screen and instructions for incorporating it into clinical settings, visit .
The Primary Care PTSD Screen may be administered in print or verbally. If administered verbally, the screening tool allows for follow-up questions and inquiring for more detail about any yes answers. These answers should give the information necessary to make an appropriate diagnosis.
Adverse Life Experiences And Post
In 2001, Shapiro introduced the ideas of classifying trauma into one of two forms: large-T trauma and small-t trauma . Large-T traumas are events that most people would experience as horrific or life-threatening. Examples of large-T traumas include assault, rape, military combat, or natural disasters. Essentially, whenever there is a life-threatening component or one perceives his or her life to be in danger, large-T trauma is involved. Large-T trauma is commensurate to what is called a Criterion A trauma in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition description of PTSD.
Although many clinicians still consider the large-T/small-t taxonomy useful, Shapiro has moved away from this original distinction, now opting for the term “adverse life experiences” . These adverse life experiences may or may not qualify for a DSM-5 diagnosis of PTSD. It is important to note that it was never intended for people to use the large-T/small-t system as a value judgment small-t trauma can be just as valid and just as clinically significant as large-T trauma . The hope is that using the term adverse life experiences will keep inadvertent value judgments from taking place.
The DSM-5 includes full diagnostic criteria for PTSD, including qualifiers and specific symptoms. However, the following abbreviated definition of the PTSD diagnosis may be used as a general framework :
Proposals For The Future Of Trauma Diagnosis And Treatment
From the time that it was introduced in 1980, some have criticized the PTSD diagnosis as being too one-dimensional. The criteria generally only apply to those who experienced a single, catastrophic trauma, and they were written primarily with combat veterans in mind. Individuals who experienced prolonged trauma over time, be it subtle or overt, are generally excluded. For example, children who grow up in dysfunctional homes and seem to be affected by that trauma may not have a single Criterion A event on which a PTSD diagnosis can be made.
In response to these criticisms, the concept of complex PTSD has been introduced . Essentially, complex PTSD refers to conditions of prolonged trauma or trauma that occurs at developmentally vulnerable times, resulting in effects more significant than is believed possible with standard PTSD. In its most updated definition, complex PTSD manifests from conditions that:
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Are repetitive or prolonged
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Involve direct harm and/or neglect or abandonment by caregivers or ostensibly responsible adults
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Occur at developmentally vulnerable times in the victim’s life, such as early childhood
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Have great potential to severely compromise a child’s development
Although not an official DSM-5 diagnosis, complex traumatic stress disorders are real to many clients and clinicians. The label of complex PTSD suggests that the healing of original traumatic wounds can be further complicated due to a variety of conditions .
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How To Cope With Mass Violence And The Effects
- Coping with Violence and Traumatic EventsThis SAMHSA website has a variety of resources for first responders, schools, adults, and families for coping with violence and traumatic events.
- Dealing with the Effects of Trauma: A Self-Help GuideThis SAMHSA guide provides more in-depth information on recovering from a traumatic event and is geared for those whose reactions may be lingering.
- Mental Health Care for Ethnic Minority Individuals and Communities in the Aftermath of Disasters and Mass ViolenceThis paper reviews research that indicates that ethnic minorities may suffer more adverse psychological consequences after disasters and mass violence than do white Americans. Guidelines are provided so that disaster behavioral health services can become more culturally responsive and traditional barriers are reduced.
Mental Health Response to Mass Violence and Terrorism: A Field GuideThis SAMHSA publication is intended for mental health and disaster workers first responders government agency employees and crime victim assistance, faith-based, healthcare, and other service providers who assist survivors and families during the
- aftermath of mass violence and terrorism. Please let us know if you would like additional free copies.
Free Psychologist Ceus Onlineceucredit
- onlineceucredit.com
- Summary: 350+ APA, ASWB, NBCC, NAADAC CEU Courses Get 30% Off Read course content and score test free! Get mp3 CEU Course content Audio Download free!
- https://www.onlineceucredit.com/free-psychologist-ceus.php
- Summary: CARAS is approved by the American Psychological Association to sponsor continuing education for psychologists. CARAS maintains responsibility for this
- https://www.carasresearch.org/apa-continuing-education
Recommended Reading: The Department Of Veterans Affairs
Resources For Traumatization And Chronic Stress
Addressing the Traumatic Impact of Disaster on Individuals, Families, and Communities
Presented at the After the Crisis Initiative: Healing from Trauma after Disasters Expert Panel Meeting. This white paper addresses healing from the trauma induced by a disaster, especially in terms of regaining normalcy and offering and receiving peer support. In addition, the paper focuses on restoring communities with the supports necessary to be sensitive to the recovery from trauma by individuals, children, and families.
Coping with Stress
This webpage from the Centers for Disease Control and Prevention provides clear, concise information on coping with stress related to a traumatic event.
Lessons Learned from School Crises and Emergencies
This publication from the U.S. Department of Education Readiness and Emergency Management for Schools discusses re-traumatization at Virginia Polytechnic Institute and State University following the 2007 campus shooting of 32 individuals.
Tips for Survivors of a Traumatic Event: Managing Your Stress
This tip sheet outlines the common signs of stress after a disaster and provides stress reduction strategies.
Trauma and Retraumatization
Tips for Survivors of a Traumatic Event: Managing Your Stress
Coping with Violence and Traumatic Events
Dealing with the Effects of Trauma: A Self-Help Guide
Professionals Outside Of Va: How To Obtain Credits Via Train
Note: Access to TRAIN requires creating an account.
- Use the TRAIN website link located on the course page. The link will take you to the course details page.
- To access the course, use the login link in the upper right corner of the page. First time users are required to register, returning users must login.
- After you login/register, TRAIN will return you to your chosen course details page.
- You will be prompted to take the post-test after completing the course to get CE/CME credits.
Need assistance with TRAIN? See the Help section on the TRAIN website or email the VHA TRAIN Team at .
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Ptsd And The Military: Depth Psychological Perspectives And Resources
A blog post by Melissa Ruisz Nazario
While post-traumatic stress disorder is not exclusive to the military and can affect anyone who has experienced any type of trauma, veterans experience a higher rate of PTSD than the general population. Yet, veterans often seek help less frequently because they dont want to be seen as weak or be treated differently. Additionally, some military leaders also believe that the term “disorder” makes suffering service members averse to seeking help, and they’ve tried to have it renamed post-traumatic stress injury, which would help reduce the stigma associated with “disorder.”
Understanding PTSD
The Diagnostic and Statistical Manual of Mental Disorders categorizes PTSD as a trauma- and stressor-related disorder triggered by exposure to actual or threatened death, serious injury, or sexual violation, and the disturbance causes significant distress and impairment of an individual’s daily life and interactions. Some symptoms include persistent re-experiencing of the traumatic events, whether through flashbacks or dreams, difficulty sleeping, avoidance of anything that reminds the sufferer of trauma, negative changes in thoughts, feelings, or perceptions related to the trauma, and changes in reactivity, such as angry outbursts.
Wounded Warriors, Initiated Warriors
A Soldiers Story: Trauma, Trickster and Transcendence
Watch the entire presentation here:
Resources for Veterans
Resources for Mental Health Care Providers
How To Get Ce Credits
Continuing education credits are offered for completing most courses. There is no fee to take a course or for obtaining continuing education credits.
- VA employees: TMS – VA’s Talent Management System
- Professionals outside of VA: TRAIN – TrainingFinder Real-time Affiliate Integrated Network
For courses that are collaborative projects between the National Center for PTSD and other organizations, you will be linked to the course website. If there are issues with a course housed outside of TMS or TRAIN, please contact the organization offering the course.
Not all courses are offered with continuing education credits. If there is no credit offered, it is indicated on the page.
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Resources Regarding Traumatic Grief In Children
- Helping children cope with violence and disasters
The National Institute for Mental Health produced this page of guidance to educators, parents, professional caregivers, and community members on practical steps that can help children cope with exposure to violence either firsthand or in the media.
- Helping children cope with violence and disasters
The National Institute for Mental Health produced this page of guidance to educators, parents, professional caregivers, and community members on practical steps that can help children cope with exposure to violence either firsthand or in the media.
- After a loved one dieshow children grieve And how parents and other adults can support them
This 26-page booklet is for parents and other adults to help children who have suffered the loss of a parent or loved one to get through their grief.
- Responding to stressful events: Helping children cope
This packet contains information on helping children cope after a stressful event. It provides information on common reactions and coping techniques.
- Talk, listen, connect: When families grieve
This collection of resources addresses the difficult topic of the death of a parent and helps families cope with complex emotions, honor the life of a loved one, and find strength in each other. There are components for military families and nonmilitary families.
- Understanding child traumatic stress
- Children and Grief
Veterans Nearing The End Of Life
The goal of this webinar was to equip healthcare professionals with an understanding of military veterans unique medical, emotional, and spiritual needs as they near the end of life.
The goal of this webinar was to equip healthcare professionals with an understanding of military veterans unique medical, emotional, and spiritual needs as they near the end of life.
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Individual State Behavioral Health Approvals
In addition to states that accept ASWB, NetCE is approved as a provider of continuing education by the following state boards: Alabama State Board of Social Work Examiners, Provider #0515 Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, CE Broker Provider #50-2405 Illinois Division of Professional Regulation for Social Workers, License #159.001094 Illinois Division of Professional Regulation for Licensed Professional and Clinical Counselors, License #197.000185 Illinois Division of Professional Regulation for Marriage and Family Therapists, License #168.000190
Ptsd In Racial And Ethnic Minorities
Some racial and ethnic minorities have higher rates of posttraumatic stress. A 2011 study of the general U.S. population found the highest rate of PTSD among black residents . White individuals had a lifetime prevalence of 7.4%, and Hispanic residents had a rate of 7.0%. Asians had the lowest rates of PTSD .
Certain minority subgroups also have higher PTSD rates. Some estimates suggest about half of Holocaust survivors have posttraumatic stress.
However, ethnic and racial prevalence rates vary between studies. How a study defines PTSD or which people it includes in a minority group can affect data. Several studies have found higher rates of PTSD among Hispanic Americans than either black or white Americans.
A PTSD diagnosis requires a person to have experienced trauma. Differences in trauma exposure may play a large role in racial and ethnic PTSD rates. Racial and ethnic minorities often face different traumas from other groups. These traumas may include:
- Racism and discrimination:Prejudice can cause distress and negative life outcomes. For instance, hiring discrimination can lead to unemployment.
- Exposure to violence: Minorities may be exposed to wars, ethnic and racialized violence, and crime. Violence by military or law enforcement officers can also be a risk.
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Suicide Survivors: Treatment And Resources
Family members and friends affected by the death of a loved one through suicide are referred to as “suicide survivors.” Conservative estimates suggesting a ratio of six survivors for every completed suicide indicate that an estimated 6 million Americans became suicide survivors in the past 25 years . One study estimated that 115 individuals are exposed to a single suicide, in addition to those who are intimately affected . Among these, one in five reported that the experience had a devastating impact or caused a major-life disruption . A similar study published in 2019 estimated rates of those affected to be 135 individuals per suicide, illustrating the wide effects of suicide .
The death of a loved one by suicide can be shocking, painful, and unexpected for survivors. The ensuing grief can be intense, complex, chronic, and nonlinear. Working through grief is a highly individual and unique process that survivors experience in their own way and at their own pace. Grief does not always move in a forward direction, and there is no time frame for grief. Survivors should not expect their lives to return to their previous state and should strive to adjust to life without their loved one. The initial emotional response may be overwhelming, and crying is a natural reaction and an expression of sadness following the loss of a loved one .
Impact On The Family System
During the post-deployment or reintegration phase, the service member returns and the entire family is involved in helping him/her integrate back into the system . There is usually a honeymoon phase, but awkwardness and tension often follow . Family roles may have changed during this time, and the returning member will need time to adjust. For example, new parenting strategies may have surfaced in order to deal with being a “single parent” during the deployment. Upon homecoming, the military member should not expect family dynamics to have remained the same, but he/she may report feeling like a guest in his/her own home . Some may not recognize their child, especially if the child was recently born or just an infant when they left. Similarly, children may not recognize the returning parent or express wariness of this returning stranger. As a result, the military parent may experience distress and hurt .
Some military families will encounter challenges during the post-deployment phase, including substance abuse, PTSD, and domestic violence. In fact, it is estimated that the rate of relationship and family problems is four times higher during this phase than the other phases . In a study involving 19,227 active U.S. soldiers from brigade combat teams who served in Iraq or Afghanistan between 2003 and 2009, problems of marital quality and separation/divorce intentions increased during the reintegration period .
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Ptsd In Modern Veterans
Due to the nature of modern warfare, veterans from Iraq and Afghanistan are especially likely to face trauma. The U.S. Department estimates 10-18% of veterans develop PTSD after they return. A soldiers risk of PTSD depends on their demographics and their experiences in combat.
Soldiers who are unmarried and have lower levels of education are more likely to have PTSD. Female service members also have higher risks of PTSD. According to a 2015 study, 5% of female soldiers reported sexual assault. In the military, women are five times more likely to experience sexual assault than men.
Soldiers who face more combat stressors are more likely to develop PTSD. Combat stressors include seeing corpses, having a comrade killed, being ambushed, and getting injured in battle. Soldiers with longer deployment periods also had higher rates of posttraumatic stress.
The Triune Brain Model
To further the role of processing, it is vital to review some basic biology. MacLean’s triune brain model suggests that the human brain actually operates as three separate minds, each with its own special role and its own respective senses of time, space, and memory . While this model’s use in terms of neuroanatomic evolution is considered by some to be outdated or oversimplified, it is useful as a purely explanatory tool. It describes the brain structure in a manner that is easy to understand and use as a conceptualization for treatment planning.
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The R-complex brain : Includes the brainstem and cerebellum. It controls reflex behaviors, muscle control, balance, breathing, and heartbeat, and is very reactive to direct stimulation.
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The limbic brain: Contains the amygdala, hypothalamus, and hippocampus. It is the source of emotions and instincts within the brain, including attachment and survival. When this part of the brain is activated, emotion is activated. According to MacLean, everything in the limbic system is either agreeable or disagreeable , and survival is based on the avoidance of pain and the recurrence of pleasure.
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The neocortex : Contains the frontal lobe and is unique to primates. The more evolved brain, it regulates executive functioning, which can include higher-order thinking skills, reason, speech, meaning, and sapience .
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