Development and Application of the Trauma Symptom Inventory - PowerPoint Presentation

Slide1

Development and Application of the Trauma Symptom Inventory™-2 (TSI™-2)Slide2

Trauma Symptom Inventory-2

(TSI™-2)

The Trauma Symptom Inventory-2 (TSI-2) is a revised version of the Trauma Symptom Inventory (TSI™; Briere, 1995), a widely used test of trauma-related symptoms and behaviors.This measure evaluates acute and chronic symptomatology, including, but not limited to, the effects of:It evaluates symptomatology associated with trauma at any point in the respondent’s lifespan; it does not link symptoms to a single stressor or specific point in time.

Sexual and physical assault

Intimate partner violence

Combat

Torture

Motor vehicle accidents

Mass casualty events

Medical trauma

Witnessing violence or other trauma

Traumatic losses

Early experiences of child abuse or neglectSlide3

136 items

Assesses a

wide range of potentially complex symptomatology. (i.e., posttraumatic stress, dissociation, somatization, and dysfunctional behaviors. Normed and standardized on a representative sample of the United States general population.It consists of 2 validity scales, 12 clinical scales, 12 subscales, and 4 factorsTrauma Symptom Inventory-2 (TSI-2)Slide4

Goals for the Revision

To update existing items and skills to reflect new developments and research in the field of trauma

To respond to feedback from clinicians and researchers regarding strengths and limitations of the TSITo provide additional scales in order to measure symptom clusters not included in the TSITo address concerns regarding utility of the original ATR scale in detecting malingering of PTSD in forensic settingsTo modify the AA scale to include hyperarousalTo provide continuity between the TSI and the TSI-2Slide5

TSI to TSI-2

Added three (3) scales -

Insecure Attachment (IA); Somatic Preoccupations (SOM); and Suicidality (SUI).Added two (2) subscales - Anxious Arousal–Hyperarousal (AA-H) and Impaired Self-Reference–Other-Directedness (ISR-OD). The four TSI™-2 factors (Self-Disturbance (SELF); Posttraumatic Stress (TRAUMA); Externalization (EXT); and Somatization (SOMA) are either new to this version (EXT) and (SOMA) or reconfigured based on newly added or modified scales (SELF) and (TRAUMA). The TSI™-2 validity scales contain new items, especially the Atypical Response (ATR) scale, which was redesigned to assess not only over-reporting in general, but also to better evaluate potential misrepresentation of posttraumatic stress

disorder (

PTSD). In all, 87 items (i.e., 64%) are new to

the

TSI-2

or have been rewritten to some degree.

Added a Reliable Change Score

N

o

racial

differences were

found on the ATR scale in the

TSI-2

.

For this reason

, the TSI™-2

does not require any adjustment of

ATR scores

for any specific racial or ethnic group.Slide6

Why the

TSI-2?

In the general population, the lifetime prevalence of PTSD is approximately 8%.Prevalence rates in combat veterans, torture survivors, rape victims, refugees, and other individuals exposed to extremely stressful events can have rates as high as 30 to 60% (Breslau, Davis, Andreski, & Peterson, 1991; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Marshall, Schell, Elliott, Berthold, & Chun, 2005; Ramchand et al., 2010; Steel et al., 2009).Copyright © 2012 by David M. Schwartz, Ph.D. All rights reserved.Slide7

Why the

TSI-2?

There is a wide variety of non-PTSD-specific symptoms that are associated with childhood and adult interpersonal victimization. These include:Mood disturbances such as anxiety, depression, or anger (e.g., Gilboa-Schechtman & Foa, 2001; Heim & Nemeroff, 2001)Somatization (e.g., Dietrich, 2003; Walker, Katon, Roy-Byrne, Jemelka, & Russo, 1993)Identity disturbance (e.g., Briere & Rickards, 2007; Cole & Putnam, 1992)Difficulties in emotional regulation (e.g., van der Kolk et al., 1996; Zlotnick, Donaldson, Spirito, & Pearlstein

, 1997

)

I

nsecure

attachment styles (e.g., Cloitre,

Stovall-McClough

, Zorbas, & Charuvastra, 2008; Harari

, Bakermans-ranenburg

, & Van IJzendoorn, 2007

)

C

hronic interpersonal difficulties (e.g., Elliott, 1994; Pietrzak, Goldstein, Malley, Johnson, & Southwick, 2009)Dissociation (e.g., Briere, Scott, & Weathers, 2005; Chu, Frey, Ganzel, & Matthews, 1999)Substance abuse (e.g., Ouimette & Brown, 2003; Najavits, 2002)Suicidal thoughts and behaviors (Bebbington et al., 2009; Panagioti, Gooding, & Tarrier, 2009)Tension reduction or externalization activities such as compulsive sexual behavior, bulimic eating, impulsive aggression, and self-mutilation (e.g., Briere & Gil, 1998; Zlotnick et al., 1997).These are not mutually exclusive!Slide8

Why the

TSI-2?

Sometimes, symptoms are diverse and appear to arise from multiple adverse events, leading some clinicians refer to complex posttraumatic outcomes, disorders of extreme stress, or complex PTSD.Sometimes, symptoms include affect dysregulation, externalizing behaviors and relational disturbances. These may be organized as DSM-IV-TR Cluster B diagnoses.Given the range of potential outcomes, administration of a measure that is limited to PTSD or some other single symptom or syndrome is unlikely to be sufficient to form an accurate or comprehensive clinical view of the trauma survivor (Courtois, 2004). Many potential moderators and mediators of posttraumatic outcomes, including degree or frequency of trauma exposure, preexisting affect regulation capacity, relational context, and comorbid psychological symptoms or disorders may make it difficult to conclude that Trauma X is associated with Outcome Y without also taking such factors into consideration.Slide9

TSI-2-A

The

alternate 126-item version of the form does not contain any sexual symptom items—the Sexual Disturbance scale (i.e., the Sexual Concerns and Dysfunctional Sexual Behavior subscales) and the sexual symptom items associated with the Externalization factor have been removed.Eight critical items help you identify issues or behaviors that potentially represent severe psychological disturbance, danger to the respondent, or danger to others.Reliable change scores are new to this edition of the measure and allow you to track progress and monitor change over time.The validation sample consisted of five non-overlapping clinical groups: combat veterans, individuals with borderline personality disorder, sexual abuse victims, victims of domestic violence, and incarcerated women. A sample of subjects simulating PTSD was used to test malingering.Slide10

Appropriate Populations

The

TSI-2 was designed as a broad-spectrum assessment of trauma-related symptoms and behaviors. It can be used to evaluate adults in a variety of clinical settings including hospitals, inpatient and outpatient clinics, and schools. It is appropriate for use with multiple presenting problems including posttraumatic stress, insecure attachment, impaired self-reference, somatization, and “acting out” behaviors. The TSI-2 was standardized and validated on men and women in the general population, ages 18 years and older. Separate normative data are available for different genders and ages.

Flesch-Kincaid

readability analyses indicate that a

fifth-grade reading

level is required to complete the

TSI-2

.