Assessing Psychological Trauma and PTSD

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Wilson, John P., And Keane, Terence M. Assessing Psychological Trauma and PTSD New York: The Guilford Press, 1997. xiv+577 pp. $50.00.This edited volume by Wilson and Keane contains 19 chapters covering fundamental issues about standardized assessment of trauma and its psychological consequences. The past two decades have seen the development of multiple instruments to assess trauma and diagnose posttraumatic stress disorder. The authors endeavor to provide clinicians and researchers with a much needed reference and guide to help make informed decisions about which instruments are best for the particular clinical situation or scientific investigation in question.The book is broken into three parts. Part 1 reviews theoretical considerations, standardized measures, and physiological techniques. The contributing authors list and discuss the advantages and disadvantages of over 20 tests; they weigh the merits of self report tests versus standardized interview and semistructured interview methodologies. The section ends with an excellent discussion of psychometric theory and its application to trauma related mental disorders.Part 2 covers the assessment of traumatic reactions among specific populations. This section includes chapters dedicated to principles of epidemiology, assessment of traumatized children, impact of trauma on couples and families, cross-cultural considerations, military-related trauma, gender issues, trauma and the severely medically ill, and traumatic bereavement. Part 3 covers specific techniques for the assessment of traumatic reactions, posttraumatic stress disorder, and dissociation. Each of seven chapters in Part 3 deals with a specific technique, instrument, or procedure to measure posttraumatic symptoms and reactions.When referring to this book, one will notice that one third of the contributing authors are affiliated with the United States Veterans Administration. Naturally, their research and clinical interests reflect this affiliation and orientation. For this reason, there is a great deal of focus on the National Vietnam Veterans Readjustment Survey, a landmark study of the effects of war trauma on combatants conducted by the Veteran's Administration in the late 1980s. The focus on American veterans is disproportionate when one considers there are 50 million refugees and displaced persons throughout the world, many of whom have suffered mass violence, atrocities, torture, human rights abuses, and traumatic separation from home and family, as well as countless others traumatized by natural disaster, family violence, and sexual violence. The book is an excellent collection of valuable information but would be much improved by more information on assessing the impact of trauma on an individual or population within their own social, cultural, and political context. Additionally, there is a heavy emphasis on assessing symptoms and very little attention to the impact of trauma on the individual's capacity to function and care for him/herself and family. Likewise, there is no discussion about how to assess the long-term consequences of violence and trauma on entire communities such as refugee populations and communities living in highly impacted war zones or disaster areas. This information is critical to understanding a community's capacity to recover and rebuild.Wilson and Keane's book will be of interest to clinicians and researchers in the area of psychological trauma. They provide a rich, well referenced survey of the field of the assessment of psychological trauma and posttraumatic stress disorder.

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