Post-Traumatic Stress Disorder

Underrecognition of PTSD, Part III

Keep calm and do your own assessments

Posted Apr 15, 2018

Michael Scheeringa
Source: Michael Scheeringa

Let’s recap Parts I and II. Posttraumatic stress disorder (PTSD) is fairly common.  Yet, historically professionals have been slow to acknowledge that PTSD can exist, especially in youths.  Studies have shown that clinicians miss the diagnosis of PTSD nearly 90% of the time. Clinicians miss the diagnosis for a variety of reasons, including poor training, avoidance of talking about trauma, and shoddy practice.  A proper assessment of PTSD requires interviewers to lead the witness with educational interviewing in order to obtain full and accurate information. 

Because you cannot count on the ordinary therapist to know what they are doing, recognition of PTSD depends on you.  Here are five things you can do:

(1) No assessment done? Ask for one. You may have to be a strong advocate to get doctors and therapists to recognize PTSD. If you believe that you or your children have been affected by traumas but your clinicians did not conduct any reviews of traumatic experiences or PTSD symptoms, you ought to bring this up or switch clinicians.

(2) Observe for patterns.  Be good watchers of your reactions or the reactions of your children. Look for trauma-related triggers that may bring out symptoms of PTSD. When doctors conduct evaluations of your children, or when you fill out questionnaires on your own, these observations will be very important because a diagnosis is based entirely on verbal reports.

(3) Collect your own data.  Is it possible that you have underestimated the severity of your own problems or your children’s problems following traumas? It may be a good time to re-calibrate. For adults, download the PTSD Checklist for DSM-5 (PCL-5) for free from the National Center for PTSD (google “national center for PTSD pcl-5”).  For children and adolescents, download the Child PTSD Checklist questionnaire for free my Scheeringa Lab website (Google “Scheeringa lab measures”). Pick the questionnaire that is appropriate for the age of your child. Suggested cutoff scores are provided. Do not wait a little while longer to see if the behavior problems will go away. Collect your own data and act now.

You may find lots of advice on the internet that patients should not try to diagnose themselves and should only trust licensed professionals to do that.  That’s official nonsense.  It’s perfectly fine, and often better, for patients to educate themselves with good instruments and take matters into their own hands.  As I described in Part II, if you wait for licensed professionals to learn what they are doing, you may be waiting a long time.

(4) Share your own data. Is it possible that your clinicians have underestimated the severity of your problems or your children’s problems? If you or your children have already been evaluated by clinicians, did the clinicians “lead the witnesses?” The clinicians should have followed up general questions with more specific questions and used examples that were specific to their traumas. If clinicians did not use this type of interviewing technique, they may have underestimated the presence of the symptoms. If you believe that this happened, collect your own data with PTSD questionnaires and give them to the clinicians.

(5) Go through the data item by item. Do you think that your clinicians or your children’s clinicians dismissed your information? Again, data may be your best weapon. You may need to take #4 a step further.  After filling out PTSD questionnaires and giving them to clinicians, ask the clinicians to go through the responses with you item by item.

I don’t mean to oversimplify things.  Assessment and treatment of psychiatric problems is complicated, but it’s also not brain surgery.  While there are some things best done in collaboration with professionals, there are many things you can do yourselves.

(Some of this material appears in Dr. Scheeringa’s book to be released April 17, 2018, They’ll Never Be the Same: A Parent’s Guide to PTSD in Youth, published by Central Recovery Press.)