I recently fielded an interesting question: for psychological testing, do judges prefer the MMPI-2 or the CAPS test? I don’t think there is a preference. It all goes to the weight of the evidence.
From a practical standpoint, I see the MMPI-2 more than the CAPS test. But that is starting to change. With the rising number of providers using the CAPS test, particularly for veterans–many of whom worked as contractors–I think that CAPS is an important tool in PTSD cases. For others who might find the CAPS test interesting, I’ve quoted a webpage from the U.S. Department of Veterans Affairs’ National Center for PTSD:
Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
The CAPS is the gold standard in PTSD assessment. The CAPS-5 is a 30-item structured interview that can be used to:
- Make current (past month) diagnosis of PTSD
- Make lifetime diagnosis of PTSD
- Assess PTSD symptoms over the past week
In addition to assessing the 20 DSM-5 PTSD symptoms, questions target the onset and duration of symptoms, subjective distress, impact of symptoms on social and occupational functioning, improvement in symptoms since a previous CAPS administration, overall response validity, overall PTSD severity, and specifications for the dissociative subtype (depersonalization and derealization).
For each symptom, standardized questions and probes are provided. Administration requires identification of an index traumatic event to serve as the basis for symptom inquiry. The Life Events Checklist for DSM-5 (LEC-5) is recommended in addition to the Criterion A inquiry included in the CAPS-5.
The CAPS was designed to be administered by clinicians and clinical researchers who have a working knowledge of PTSD, but can also be administered by appropriately trained paraprofessionals. The full interview takes 45-60 minutes to administer.
Changes from previous CAPS for DSM-IV
Several important revisions were made to the CAPS in updating it for DSM-5:
- CAPS for DSM-IV asked respondents to endorse up to three traumatic events to keep in mind during the interview. CAPS-5 requires the identification of a single index trauma to serve as the basis of symptom inquiry.
- CAPS-5 is a 30-item questionnaire, corresponding to the DSM-5 diagnosis for PTSD. The language of the CAPS-5 reflects both changes to existing symptoms and the addition of new symptoms in DSM-5. CAPS-5 asks questions relevant to assessing the dissociative subtype of PTSD (depersonalization and derealization), but no longer includes other associated symptoms (e.g., gaps in awareness).
- As with previous versions of the CAPS, CAPS-5 symptom severity ratings are based on symptom frequency and intensity (except for amnesia and diminished interest which are based on amount and intensity). However, CAPS-5 items are rated with a single severity score in contrast to previous versions of the CAPS which required separate frequency and intensity scores.
- General instructions and scoring information are included with the CAPS-5.
Detailed scoring information is included with the CAPS-5 and should be reviewed carefully before administering. Briefly, the assessor combines information about frequency and intensity of an item into a single severity rating. CAPS-5 total symptom severity score is calculated by summing severity scores for the 20 DSM-5 PTSD symptoms. Similarly, CAPS-5 symptom cluster severity scores are calculated by summing the individual item severity scores for symptoms corresponding to a given DSM-5 cluster: Criterion B (items 1-5); Criterion C (items 6-7); Criterion D (items 8-14); and, Criterion E (items 15-20). A symptom cluster score may also be calculated for dissociation by summing items 19 and 20.
- At least one Criterion B symptom
- At least one Criterion C symptom
- At least two Criterion D symptoms
- At least two Criterion E symptoms
- Criterion F is met (disturbance has lasted one month)
- Criterion G is met (disturbance causes either clinically significant distress or functional impairment)
In the past month, have you had any unwantedmemories of (EVENT) while you were awake, so not counting dreams?
How does it happen that you start remembering (EVENT)?
[If not clear:] (Are these unwanted memories, or are you thinking about [EVENT] on purpose?)
How much do these memories bother you?
Are you able to put them out of your mind and think about something else?
How often have you had these memories in the past month?
0. Absent: The respondent denied the problem or the respondent’s report doesn’t fit the DSM-5 symptom criterion.
1. Mild / subthreshold: The respondent described a problem that is consistent with the symptom criterion but isn’t severe enough to be considered clinically significant. The problem doesn’t satisfy the DSM-5 symptom criterion and thus doesn’t count toward a PTSD diagnosis.
2. Moderate / threshold: The respondent described a clinically significant problem. The problem satisfies the DSM-5 symptom criterion and thus counts toward a PTSD diagnosis. The problem would be a target for intervention. This rating requires a minimum frequency of 2 x month or some of the time (20-30%) PLUS a minimum intensity of Clearly Present.
3. Severe / markedly elevated: The respondent described a problem that is above threshold. The problem is difficult to manage and at times overwhelming, and would be a prominent target for intervention. This rating requires a minimum frequency of 2 x week or much of the time (50-60%) PLUS a minimum intensity of Pronounced.
4. Extreme / incapacitating: The respondent described a dramatic symptom, far above threshold. The problem is pervasive, unmanageable, and overwhelming, and would be a high-priority target for intervention.
There are three versions of the CAPS-5 corresponding to different time periods: past week, past month, and worst month (lifetime). The past week version of the CAPS-5 should be used only to evaluate PTSD symptoms over the past week. PTSD diagnostic status should be evaluated with the past month (for current PTSD) or worst month (for lifetime PTSD) versions of the CAPS-5.
A version for children and adolescents ages 7 and above (CAPS-CA-5) is also available. The CAPS-CA-5 corresponds to DSM-5.
Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M. (2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Interview available from the National Center for PTSD at www.ptsd.va.gov.
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. (PDF) Journal of Traumatic Stress, 8, 75-90. doi: 10.1002/jts.2490080106
Gray, M., Litz, B., Hsu, J., & Lombardo, T. (2004). Psychometric properties of the Life Events Checklist. (PDF) Assessment, 11, 330-341. doi: 10.1177/1073191104269954
Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician-Administered PTSD Scale: A review of the first ten years of research. (PDF) Depression and Anxiety, 13, 132-156. doi: 10.1002/da.1029
Weathers, F. W., Ruscio, A. M., & Keane, T. M. (1999). Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. (PDF) Psychological Assessment, 11, 124-133. doi: 10.1037//1040-35184.108.40.206