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UCLA PTSD Reaction Index: DSM-5

Version

Alan M. Steinberg
Brittany Beyerlein

UCLA/Duke University National Center for Child Traumatic Stress


University of California, Los Angeles
Overview
DSM-5 Diagnostic Criteria for PTSD
UCLA PTSD Reaction Index for DSM-5
Trauma History Profile
Symptom Scale (now includes B, C, D, & E)
Frequency Rating Sheet
Clinician Checklist (to determine clinically significant distress or
functional impairment)
Scoring Worksheet
Frequently Asked Questions
PTSD: Major Changes from DSM-IV to DSM-5

Tightening of the A1 Criterion


Eliminating the A2 Criterion (fear, horror, helplessness)
4 (rather than 3) Symptom Clusters
Special Criteria for Preschool Children (children 6 and
younger)
Addition of a Dissociative Subtype
DSM-5 Diagnostic Criteria for PTSD
Note: The following criteria apply to adults, adolescents, and children older than 6 years.
For children 6 years and younger, refer to the corresponding criteria in the DSM-5.
DSM-5 Diagnostic Criteria for PTSD
Criterion A
A) Exposure to actual or threatened death, serious injury, or
sexual violence in one (or more) of the following ways:
1) Directly experiencing the traumatic event.
2) Witnessing, in person, the event as it occurred to others.
3) Learning that the traumatic event occurred to a close family
member or friend. In cases of actual or threatened death of a
family member or friend, the event must have been violent or
accidental.
4) Experiencing repeated or extreme exposure to aversive details of the
traumatic event (e.g., first responders collecting human remains;
police officers repeatedly exposed to details of child abuse).

Note: Criterion A4 does not apply to exposure through electronic media,


television, movies, or pictures, unless this exposure is work related
DSM-5 Diagnostic Criteria for PTSD
Cluster B
Presence of 1 of the following intrusion symptoms associated
w/ the traumatic event(s), beginning after the traumatic
event(s) occurred:
Recurrent, involuntary, & intrusive distressing memories of the event.
*Repetitive play w/ trauma themes
Recurrent distressing dreams related to the event.
*May have frightening dreams w/o recognizable content
Dissociative reactions (e.g., flashbacks) in which the individual feels/acts
as if the event were recurring.
*Trauma-specific reenactment may occur in play
Psychological distress at cues resembling event.
Physiological reactions to cues resembling the event.
*Specifiers for children over 6
DSM-5 Diagnostic Criteria for PTSD
Cluster C
Persistent avoidance of stimuli associated w/ the traumatic
event(s), beginning after the traumatic event(s) occurred, as
evidenced by 1 of the following:

Avoidance of or efforts to avoid distressing memories, thoughts, or


feelings about or closely associated with the traumatic event.

Avoidance of or efforts to avoid external reminders (people, places,


conversations, activities, objects, situations) that arouse distressing
memories, thoughts, or feelings about or closely associated with the
traumatic event.
DSM-5 Diagnostic Criteria for PTSD
Cluster D
Negative alterations in cognitions & mood associated w/ the
traumatic event(s), beginning or worsening after the traumatic
event(s) occurred, as evidenced by 2 of the following:
Inability to remember an important aspect of the event (not due to head
injury or substance use).
Persistent & exaggerated negative beliefs or expectations about oneself,
others, or the world (e.g., I am bad, No one can be trusted).
Persistent, distorted cognitions about the cause or consequences of the
event that lead the individual to blame himself/herself or others.
Persistent negative emotional state (e.g., fear, anger, guilt, or shame).
Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions.
DSM-5 Diagnostic Criteria for PTSD
Cluster E
Marked alterations in arousal & reactivity associated w/ the
traumatic event(s), beginning or worsening after the traumatic
event(s) occurred, as evidenced by 2 of the following:
Irritable behavior & angry outbursts (w/ little or no provocation)
typically expressed as verbal or physical aggression.
Reckless or self-destructive behavior.
Hypervigilance.
Exaggerated startle response.
Problems w/ concentration.
Sleep disturbance
DSM-5 Diagnostic Criteria for PTSD

F) Duration of the disturbance (Criteria B, C, D, &


E) is > 1 month.
G) The disturbance causes clinically significant
distress or impairment in social, occupational,
or other important areas of functioning.
H) The disturbance is not attributable to the
physiological effects of a substance or other
medical condition.
DSM-5 Diagnostic Criteria for PTSD
Dissociative Subtype
Specify whether the individuals symptoms meet criteria for
PTSD, and in addition, the individual experiences persistent
or recurrent symptoms of either of the following:
Depersonalization: experiences of feeling detached from, and as if
one were an outside observer of, ones mental processes or body
(e.g., feeling as though one were in a dream; feeling a sense of
unreality of self or body or of time moving slowly).
Derealization: experiences of unreality of surroundings (e.g., the
world around the individual is experienced as unreal, dreamlike,
distant, or distorted).
UCLA PTSD Reaction Index for DSM-5

Self-report instrument to screen for trauma


exposure and assess for DSM-5 PTSD symptoms
There is also a caregiver-report version

Appropriate for children over 6 years of age

Provides preliminary DSM-5 diagnostic information


and PTSD symptoms frequency score
Trauma History Profile: Part I

Clinician-administered trauma exposure screener


Prompts clinician to assess age and features of
exposure
Utilizes all available sources of information (e.g.,
self-report trauma screener, DCFS reports,
caregiver interview)
Completed at intake and updated over course of
treatment
Trauma History Profile: Part I
(clinician administered)
Trauma Type Trauma Details Role in Event Age(s) Experienced

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Physical Victim
Neglect/Maltreatment Psychological Witness
Penetration Non-Family Victim
Intra-familial CPS Report Witness
Sexual Abuse Learned about

Serious Injury Victim


Physical Abuse Weapon Used Witness
CPS Report Learned about
Caregiver Substance Abuse Victim
Emotional Abuse Other _________________ Witness
Weapon Used Victim
Domestic Violence Serious Injury Witness
Report Filed Learned about
Gang-Related Victim
Community Violence High Crime Community Witness
Drug Traffic Other ____ Learned about
Specify: _______________ Victim
War/Political Violence ________________________ Witness
________________________ Learned about
Trauma Type Trauma Details Role in Event Age(s) Experienced

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Type _________________ Self
Life-Threatening Medical _______________________ Family
Illness _______________________ Friend
Motor Vehicle Victim
Dog Bite Hospitalized Witness
Serious Accident
Other ________________ Learned about

Shooting Bullying Victim


School Violence Suicide Assault Witness
Other _________________ Learned about
Earthquake Fire Flood
Hurricane Tornado Victim
Disaster Toxic Substance Other __ Witness
_______________________ Learned about
Lost Home Injured
Conventional Weapon
Biological Chemical Victim
Terrorism Radiological Other _____ Witness
Learned about
Stranger Victim
Kidnapping Relative Witness
Acquaintance Other ____ Learned about
Weapon Used Victim
Sexual Assault/Rape Stranger Witness
Date Rape Prosecution Learned about

Robbery Assault Victim


Interpersonal Violence Homicide Suicide Witness
Suicide Attempt Other _ Learned about
_______________________

Parent Sibling Witness


Friend Other Relative Learned about
Other _________________ (exclude death due to
Sudden Death natural causes)
Bereavement Cause of Death: Illness
Accident Homicide
Suicide Disaster
Terrorism Other________
______________________
Trauma Type Trauma Details Role in Event Age(s) Experienced

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Divorce
Foster Care
Parent Deported
Parent/Sibling Incarcerated
Parent Hospitalized
Separation Refugee
Separation from relatives/ friends
in country of origin
Other _________________

Biological Mother
Biological Father
Other Relative
Other Adult
Impaired Caregiver Impairment Due to:
Drug use/abuse/addiction
Mental Health Problem
Medical Illness
Other _________________

2013: Robert S. Pynoos, M.D., M.P.H. and Alan M. Steinberg, Ph.D. All rights reserved.
Trauma History Profile: Part II
Self-report screener for trauma exposure history (Items 1-15)
Administered verbally or completed independently by
child/adolescent
Assesses 14 types of trauma exposure using yes/no format
Child should write a brief description of the trauma
If the child endorses multiple types of trauma exposure, child
should indicate which trauma type is currently the most
bothersome and indicate when this occurred.
Clinician should write a brief description of the trauma that is
currently most bothersome (if different from childs original
description)
Trauma History Profile: Part II
(self-report screener)

SELF-REPORT TRAUMA HISTORY: In interviewing the child/adolescent, ask: Sometimes people have scary or violent things that
happen to them where someone could have been or was badly hurt or killed. Has anything like this ever happened to you?
1. Provide a brief description of what happened:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

Below is a list of other scary or violent things that can happen. For each question, check Yes if this has happened to you; check No if this did
NOT happen to you.
2. Were you in a disaster, like an earthquake, wildfire, hurricane, tornado or flood? Yes No
3. Were you in a bad accident, like a serious car accident or fall? Yes No
4. Were you in a place where a war was going on around you? Yes No
5. Were you hit, punched, or kicked very hard at home?
(DO NOT INCLUDE play fighting between brothers and sisters.) Yes No

6. Did you see a family member being hit, punched or kicked very hard at home?
(DO NOT INCLUDE play fighting between brothers and sisters). Yes No

7. Were you beaten up, shot at, or threatened to be hurt badly in your school,
neighborhood or town? Yes No

8. Did you see someone who was beaten up, shot at or killed? Yes No
9. Did you see a dead body (do not include funerals)? Yes No
10. Did someone touch your private parts when you did not want them to? (DO NOT INCLUDE visits to
Yes No
the doctor.)
11. Did you see or hear about the violent death or serious injury of a loved one or friend?
Yes No
12. Did you have a painful or scary medical treatment when you were very sick or badly injured?
Yes No
13. Were you ever forced to have sex with someone against your will?
Yes No
14. Has anyone close to you died?
Yes No
15. OTHER than the things described above, has ANYTHING ELSE ever happened to you that was
REALLY SCARY OR UPSETTING? Yes No

If the answer is "YES" to only ONE question in the above list (#1 to #15), place the number of that question in this blank: #________. If
the answer is "YES" to MORE THAN ONE QUESTION, choose the thing that BOTHERS YOU THE MOST NOW and place the
question number in this blank: # ______

About how old were you when this bad thing happened? _______

Clinician: Provide a brief description of what is most bothersome now (if different from #1 above):
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________________________________________________________________
2013: Robert S. Pynoos, M.D., M.P.H. and Alan M. Steinberg, Ph.D. All rights reserved.
Updated Symptom Scale

27 items to assess PTSD symptoms


4 additional items (#s 28-31) to assess Dissociative
Subtype
Administered verbally or completed independently by
child/adolescent
When answering questions, the child should think about
the traumatic event that is most bothersome to him/her
currently
Child rates the frequency of symptoms in the past month
Symptom Scale: Frequency Rating Sheet

Introduce the Frequency Rating Sheet to client before


completing symptom scale

Check for understanding by asking sample questions

Use objective time anchors to define past month

Separate Frequency Rating Sheet from packet for client


use as a visual reference
Introducing the PTSD-RI Frequency Rating Sheet

Now I am going to ask you about some reactions people sometimes have after very bad things
happen to them like [the trauma]. Im going to read you some statements, and then use the
Frequency Rating Sheet to answer HOW OFTEN you have had the reaction in the past MONTH, that
is since _____.

Here are your choices to answer the next question [hand Frequency Rating Sheet to client and
point to the calendar as you explain the rating choices]. 0 means that in the past month, you have
not had the reaction at all. 1 means that you have had the reaction a LITTLE of the time, about
once every other week. See the 2 Xs on the calendar? 2 means that you have had the reaction
SOME of the time, about 1-2 times each week. 3 means that you have had the reaction MUCH of
the time, about 2-3 times each week. 4 means that you have had the reaction MOST of the time,
almost every day.

Lets do some practice questions to make sure you get how to use the calendar. If I read the
statement, I have had a headache, point to the number on the calendar that tells how often in the
past month, since ____, you have had a headache. What about the statement, I have had green
hair? Point to the number on the calendar that tells how often in the past month you have had
green hair.
UCLA PTSD Reaction Index for Children/Adolescents
DSM-5
HOW MUCH OF THE TIME DURING THE PAST MONTH None Little Some Much Most
I am on the lookout for danger or things that I am afraid of (like looking over my shoulder even when
1E3 0 1 2 3 4
nothing is there).
2D2 I have thoughts like I am bad. 0 1 2 3 4
3C2 I try to stay away from people, places, or things that remind me about what happened. 0 1 2 3 4
4E1 I get upset easily or get into arguments or physical fights. 0 1 2 3 4
I feel like I am back at the time when the bad thing happened, like its happening all over again.
5B3 0 1 2 3 4
6D4 I feel like what happened was sickening or gross. 0 1 2 3 4
7D5 I dont feel like doing things with my family or friends or other things that I liked to do. 0 1 2 3 4
8E5 I have trouble concentrating or paying attention. 0 1 2 3 4
9D2 I have thoughts like, The world is really dangerous. 0 1 2 3 4
10B2 I have bad dreams about what happened, or other bad dreams. 0 1 2 3 4
11B4 When something reminds me of what happened I get very upset, afraid, or sad. 0 1 2 3 4
12D7 I have trouble feeling happiness or love. 0 1 2 3 4
13C1 I try not to think about or have feelings about what happened. 0 1 2 3 4
When something reminds me of what happened, I have strong feelings in my body like my heart beats
14B5 0 1 2 3 4
fast, my head aches or my stomach aches.
I am mad with someone for making the bad thing happen, not doing more to stop it, or to help after.
15D3 0 1 2 3 4
16D2 I have thoughts like I will never be able to trust other people. 0 1 2 3 4
17D6 I feel alone even when I am around other people. 0 1 2 3 4
I have upsetting thoughts, pictures or sounds of what happened come into my mind when I dont
18B1 0 1 2 3 4
want them to.
19D3 I feel that part of what happened was my fault. 0 1 2 3 4
20E2 I hurt myself on purpose. 0 1 2 3 4
21E6 I have trouble going to sleep, wake up often, or have trouble getting back to sleep. 0 1 2 3 4
22D4 I feel ashamed or embarrassed over what happened. 0 1 2 3 4
UCLA PTSD Reaction Index for Children/Adolescents
DSM-5

0 1 2 3 4
23D1 I have trouble remembering important parts of what happened.

24E4 I feel jumpy or startle easily, like when I hear a loud noise or when something surprises me. 0 1 2 3 4

25D4 I feel afraid or scared.


0 1 2 3 4
26E2 I do risky or unsafe things that could really hurt me or someone else.
0 1 2 3 4
27D4 I want to get back at someone for what happened.
0 1 2 3 4
With Dissociative Symptoms (Dissociative Subtype)

28A1 I feel like I am seeing myself or what I am doing from outside my body (like watching myself in a 0 1 2 3 4
movie).

29A1 I feel not connected to my body, like Im not really there inside.
0 1 2 3 4
30A2 I feel like things around me look strange, different, or like I am in a fog.
0 1 2 3 4
31A2 I feel like things around me are not real, like I am in a dream.
0 1 2 3 4

2013: Robert S. Pynoos, M.D., M.P.H. and Alan M. Steinberg, Ph.D. All rights reserved.
UCLA PTSD Reaction Index for Children/Adolescents
DSM-5
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment.
Clinically Significant Distress: (check if youth endorses #1 below)
Yes No 1. Do these reactions (thoughts and feelings) bother or upset you a lot?

Clinically Significant Functional Impairment: (check if functional impairment at home, at school, in peer relationships, in developmental progression)

Home: (check if youth endorses #1, #2 or #3 below)


Yes No 1. Do these reactions (thoughts and feelings) make it harder for you to get along with people at home?
Yes No 2. Do these reactions (thoughts and feelings) get you into trouble at home?
Yes No 3. Do these reactions (thoughts and feelings) cause some other problem at home?
Describe: _______________________________________________________________________________________________________

School: (check if youth endorses #1 or #2 below)


Yes No 1. Do these reactions (thoughts and feelings) make it harder for you to do well in school?
Yes No 2. Do these reactions (thoughts and feelings) cause other problems at school?
Describe: _______________________________________________________________________________________________________

Peer Relationships: (check if youth endorses #1 below)


Yes No 1. Do these reactions (thoughts and feelings) make it harder for you to get along with your friends or make new friends?
Describe: _______________________________________________________________________________________________________

Developmental Progression: (check if youth endorses #1 below)


Yes No 1. Do these reactions (thoughts and feelings) make it harder for you to do important things that other kids your age are doing?
Yes No 2. Other (describe) _____________________________________________________________________________
________________________________________________________________________________________________________

2013: Robert S. Pynoos, M.D., M.P.H. and Alan M. Steinberg, Ph.D. All rights reserved.
UCLA PTSD Reaction Index for Children/Adolescents DSM-5
Score Sheet
For Items 2, 9, and 16: indicate highest score only for DSM-5 Symptom D2; for Items 15 and19: indicate highest score only for DSM-
5 Symptom D3; for Items 6, 22, 25, and 27: indicate highest score only for DSM-5 Symptom D4; for Items 20 and 26: indicate highest
score only for DSM-5 Symptom E2. Category B Total: Sum scores for symptoms B1-B5; Category C Total: Sum scores for symptoms
C1 and C2; Category D Total: Sum scores for symptoms D1-D7; Category E Total: Sum scores for symptoms E1-E6; PTSD-RI Total
Scale Score: Sum Category B, C, D, and E.
Item DSM-5 Score Item DSM-5 Score DSM-5 Score Dissociative Symptoms
Item #
# Symptom (0-4) # Symptom (0-4) Symptom (0-4) 28. A1 ____
18 B1 4 E1 29. A1 ____
23 D1 (Indicate highest score for A1) ___
10 B2 20* E2
2* D2 ____ 30. A2 ____
5 B3 26* E2
9* D2 ____ 31. A2 ____
11 B4 16* D2 1 E3 (Indicate highest score for A2) ___
14 B5 15* D3 24 E4
SYMPTOM CATEGORY 19* D3 ____ 8 E5
B SUMMATIVE SCORE: 6* D4 PTSD-RI TOTAL SCALE SCORE
______ 21 E6
22* D4 ____ ________
13 C1 SYMPTOM CATEGORY E
25* D4
SUMMATIVE SCORE
3 C2 27* D4
______
SYMPTOM CATEGORY 7 D5
DSM-5 PTSD DIAGNOSIS
C SUMMATIVE SCORE: 17 D6
B: One or more Category B symptoms present:
______ 12 D7 C: One or more Category C symptoms present:
SYMPTOM CATEGORY D: Two or more Category D symptoms present:
D SUMMATIVE SCORE: E: Two or more Category E symptoms present:
______ F: Symptom duration greater than one month:
G: Symptoms cause clinically significant distress or impairment:
Specify Dissociative Subtype:
One or more dissociative symptoms present:

Estimating Whether DSM-5 PTSD Category B, C, D, and E Symptom Criteria are Met
If symptom score is 3 or 4, then score symptom as present. For question #4, #10, and #26; use a rating of 2 or more for symptom presence. Then determine
whether one or more B symptoms are present; whether one or more C symptoms are present; whether two or more D symptoms are present; and whether two
or more E symptoms are present. If one or more Dissociative Symptoms are present, then assign Dissociative Subtype.
Scoring Instructions
Use PTSD-RI Score Sheet to tabulate symptom category
scores and total scale score
PTSD-RI Total Scale Score: Sum Category B, C, D, & E

Count highest score only for alternatively worded items of the


same symptom

DSM-5 Score
Item #
Symptom (0-4)
4 E1
Example of scoring a symptom 20* E2
____
category: 26* E2
1 E3
For Items 20 & 26, indicate highest 24 E4

score only for Symptom E2. 8 E5


21 E6
Category E total: Sum scores for SYMPTOM CATEGORY E

symptoms E1-E6
SUMMATIVE SCORE
______
Scoring Instructions
Estimating whether DSM-5 PTSD category B, C, D, and E
symptom criteria are met:
If symptom score is 3 or 4, score symptoms as present
For questions 4, 10, & 26; use a rating of 2 or more for symptom
presence
Then determine whether one or more B symptoms are present; whether
one or more C symptoms are present; whether two or more D symptoms
are present; and whether two or more E symptoms are present.
Determine if symptoms duration has been greater than one month
Determine if symptoms cause clinically significant distress/impairment
If one or more Dissociative Symptoms
are present, then assign DSM-5 PTSD DIAGNOSIS
Dissociative Subtype. B: One or more Category B symptoms present:
C: One or more Category C symptoms present:
D: Two or more Category D symptoms present:
E: Two or more Category E symptoms present:
F: Symptom duration greater than one month:
G: Symptoms cause clinically significant distress or impairment:
Specify Dissociative Subtype:
One or more dissociative symptoms present:
Frequently Asked Questions
Multiple trauma exposure
Method of administration (group, interview, paper-and-pencil,
computer assisted administration)
PTSD-RI score and PTSD diagnosis
Partial PTSD
Translations
Psychometrics (not yet available for the DSM-5 version)
Elhai, J. D., Layne, C. M., Steinberg, A. S., Brymer, M. J., Briggs, E. C., Ostrowski, S. A., & Pynoos, R. S. (2013).
Psychometric properties of the UCLA PTSD Reaction Index. Part II: Investigating factor structure findings in a national
clinic-referred youth sample. Journal of Traumatic Stress, 26, 10-18. doi:10.1002/jts.21755
Steinberg, A. M., Brymer, M. J., Kim, S., Ghosh, C., Ostrowski, S. A., Gulley, K., Briggs, E. C., & Pynoos, R. S. (2013).
Psychometric properties of the UCLA PTSD Reaction Index: Part 1. Journal of Traumatic Stress, 26, 1-9.
doi:10.1002/jts.21780.
Contractor, A. A., Layne, C. M., Steinberg, A. M., Ostrowski, S. A., Ford, J. D., & Elhai, J. D. (2013). Do gender and age
moderate the symptom structure of PTSD? Findings from a national clinical sample of children and adolescents.
Psychiatry Research, 210(3), 1056-1064. http://dx.doi.org/10.1016/j.psychres.2013.09.012
Obtaining the UCLA PTSD-RI

For information about obtaining the PTSD Reaction


Index for DSM-5, please contact Preston Finely at
hfinley@mednet.ucla.edu