CAPS - Clinician Administered PTSD Scale

CAPS - Clinician Administered PTSD Scale
(to be completed by a trained clinician)

Traumatic Event Exposure(s)	Happened to me	Witnessed it	Learned about it	Not sure	Doesn't apply
1. Natural disaster (for example, flood, hurricane, tornado, earthquake)
2. Fire or explosion
3. Transportation accident (for example, car accident, boat accident, train wreck, plane crash)
4. Serious accident at work, home, or during recreational activity
5. Exposure to toxic substance (for example, dangerous chemical, radiation)
6. Physical assault (for example, being attacked, hit, slapped, kicked, beaten up)
7. Assault with a weapon (for example, being shot, stabbed, threatened with a knife, gun, or bomb
8. Sexual assault (rape, attempted rape, made to perform anytype of sexual act through force or threat of harm)
9. Other unwanted or uncomfortable sexual experience
10. Combat or exposure to a war-zone (in the military or as a civilian)
11. Captivity (for example, being kidnapped, abducted, help hostage, prisoner of war)
12. Life-threatening illness or injury
13. Severe human suffering
14. Sudden, violent death (for example homicide, suicide)
15. Sudden, unexpected death of someone close to you
16. Serious injury, harm, or death you caused to someone else
17. Any other very stressful event or experience

If the person has been exposed to a traumatic event, continue with form.
Describe any event or events as related to symptoms below.

DSM-IV Criteria for PTSD and CAPS format summary:

For the rest of the interview, I want you to keep (EVENTS) in mind as I ask you some questions about how they may have affected you.

Criterion A:

A. Event No - Yes

1) The person experienced, witnessed, or was confronted with an event or events that involved: actual or threatened death or serious injury, or a threat to the physical integrity of self or others

2a) The person's response involved intense fear



2b) The person's response involved, helplessness



2c) The person's response involved horror

I’m going to ask you about twenty-five questions altogether. Most of them have two parts.
First, I’ll ask if you’ve ever had a particular problem, and if so, about how often in the past month (week).
Then I’ll ask you how much distress or discomfort that problem may have caused you.
Then I will ask you the question for your whole life.

FREQUENCY:
0 = "Never"
1 = "Once or twice in the past month"
2 = "Once or twice a week"
3 = "Several times a week"
4 = "Daily or almost every day"

Intensity: 0 = "None"
1 = "Mild, minimal distress or disruption of activities"
2 = "Moderate, distress clearly present but still manageable, some disruption of activities"
3 = "Severe, considerable distress, difficulty dismissing memories, marked disruption of activities"
4 = "Extreme, incapacitating distress, cannot dismiss memories, unable to continue activities"

Criterion B. The traumatic event is persistently re-experienced in one (or more) of the following ways:

B. Reexperiencing symtoms	Last Month		Life Time
	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4
1(1) intrusive recollections
2(2). distressing dreams
3(3) acting or feeling as if event were recurring
4(4) psychological distress at exposure to cues
5(5) physiological reactivity on exposure to cues

Criterion C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness
(not present before the trauma), as indicated by three (or more) of the following:

C. Avoidance and numbing symptoms	Last Month		Life Time
	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4
1(6) avoidance of thoughts or feelings
2(7) avoidance of activities, places, or people
3(8) inability to recall important aspect of trauma
4(9) diminished interest in activities
5(10) detachment or estrangement
6(11) restricted range of affect
7(12) sense of a foreshortened future

Criterion D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

D. Hyper-arousal symptoms	Last Month		Life Time
	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4
1(13) difficulty falling or staying asleep
2(14) irritability or outbursts of anger
3(15) difficulty concentrating
4(16) hypervigilance
5(17) exaggerated startle response

E. Duration of disturbance, onset of symptoms
(If not already clear, ask: "When did you first start having (PTSD SYMPTOMS) youv'e told me about?"
(How long after the trauma did they start? More than six months?)

E. Onset

(18) total # months delay in onset? 0: 1: 2: 3: 4: 5: 6: More than 6:

E. Duration	No - Yes
(19m) duration of current disturbance at least one month
(19l) duration of disturbances over life-time at least one month

Criterion F. Significant distress or impairment in functioning

F. Distress	Last Month	Life Time
	Intensity 0 1 2 3 4	Intensity 0 1 2 3 4
20. subjective distress
21. impairment in social functioning
22. impairment in occupational functioning

G. Global ratings - PTSD criteria

Global ratings	Score 0 1 2 3 4	Insufficient information
23. global validity
24. global severity
25. global improvement

ASSOCIATED FEATURES

Associate Features	Last Month		Life Time
	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4	Frequency 0 1 2 3 4	Intensity 0 1 2 3 4
1(26) guilt over acts of commission or omission
2(27) survivor guilt
3(28) reduction in awareness of surroundings
4(29) derealization
5(30) depersonalization

PTSD diagnosis PTSD PRESENT -- ALL CRITERIA (A-F) MET?

(CAPS maximum score = 136)

0    -  19      normal
20  -  39      mild
40  -  59      moderate
60  -  69      severe
80 and above    extreme

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Last update: 06/27/2011

A. Event	No - Yes
1) The person experienced, witnessed, or was confronted with an event or events that involved: actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2a) The person's response involved intense fear
2b) The person's response involved, helplessness
2c) The person's response involved horror