Concurrent Validity of a Crime-Related Post-Traumatic Stress Disorder Scale for Women within the Symptom Checklist-90-Revised
Arata, Catalina Mandoki, Saunders, Benjamin E., Kilpatrick, Dean G., Violence and Victims
Using a structured interview to obtain a lifetime history of criminal victimization, a community sample of 266 adult women who had experienced at least one incident of victimization was identified. These women were administered the Symptom Checklist-90-Revised, the Impact of Event Scale, and a structured clinical interview was used to identify Crime-Related Post-Traumatic Stress Disorder (CR-PTSD). A recently derived scale based on responses to items on the SCL-90-R was compared to the IES for predicting current diagnosis of Crime-Related PostTraumatic Disorder. Both the scale and the IES were found to improve prediction of CR-PTSD above base rates and to perform in a similar manner. The utility of each of these scales as a screening measure is discussed.
Post-Traumatic Stress Disorder (PTSD) is described in DSM-III-R (American Psychiatric Association, 1987) as a disorder where, following an event outside the range of usual human experiences, a person re-experiences the traumatic event (e.g., intrusive thoughts, nightmares, flashbacks) and has symptoms of emotional numbing/avoidance (e.g., avoidance of reminders of the trauma, diminished interest in activities) and increased physiological arousal (e.g., sleep difficulty, hypervigilance). While PTSD has traditionally been studied among Vietnam veterans (Fairbank, Keane, & Malloy, 1983; Foy, Sipprelle, Rueger, & Carroll, 1984; Keane, Malloy, & Fairbank, 1984), recent studies have found that many victims of violent crime also develop symptoms of PTSD following their victimization (Burgess & Holmstrom, 1985; Holmes & St. Lawrence, 1983; Steketee & Foa, 1987; Kilpatrick, Saunders, Veronen, Best, & Von, 1987; Kilpatrick et al., 1989). For example, victims of rape often experience fear and anxiety, intrusive imagery and nightmares, sleep disturbance, guilt, and impairment in social and sexual functioning following the assault (Steketee & Foa, 1987).
While the literature on sexual assault suggests that this symptom pattern is characteristic of rape victims, there has been little empirical work that has employed DSM-III-R diagnostic criteria in systematically assessing the incidence and prevalence of PTSD among victims of sexual assault and other violent crimes. The few studies which have assessed PTSD among these victims however, have identified high rates of PTSD with a substantial portion of rape victims describing symptoms of PTSD both immediately following the crime and during the weeks and months which follow the incident (Burge, 1988; Kilpatrick et al., 1987; Kramer & Green, 1989; Rothbaum & Foa, 1988). In studies of women who were sexually abused as children, it has been found that nearly all the women currently in treatment met DSM-III criteria for PTSD (Donaldson & Gardner, 1985; Lindberg & Distad, 1985).
Clearly, PTSD is a significant mental health problem among crime victims, especially victims of sexual assault. One of the major limitations in the study of CR-PTSD among victims of sexual assault and other crimes has been the paucity of adequate assessment measures. The majority of the studies cited above were able to obtain estimates of the prevalence of PTSD through the careful use of structured and semi-structured interviews which specifically addressed the symptoms required to meet diagnostic criteria for PTSD. While structured clinical interviews are recommended for diagnosing PTSD (Keane, Wolfe, & Taylor, 1987), interviews can be unreliable or invalid depending on the screening questions and interview techniques used, as well as the training and sensitivity of the interviewer (Best, Kilpatrick, Kramer, & McNeil-Harkins, in press). Best et al. (in press) suggested that low prevalence rates can be due, in part, to inadequate screening and interviewing techniques which may have failed to identify many crime victims. Saunders, Kirkpatrick, Resnick, & Tidwell (1989) found that most victims of serious violent crimes were not detected at intake interviews using normal methods. …