TEST FOR SPECIAL POPULATION:

A WRITTEN REPORT ON CLINICIAN-ADMINISTERED PTSD SCALE

FOR DSM-5 (CAPS-5)

BACHELOR OF SCIENCE IN PSYCHOLOGY

SUBMITTED BY:

KATE C. PEDRITA

BS PSYCHOLOGY 3A

SUBMITTED TO:

RUDJIA FAITH ANINO

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

PSYCHOLOGICAL ASSESSMENT

SEPTEMBER 2023
 Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

I. CAPS-5: An Overview

In 1989, a structured interview consisting of 30 items was created by professionals at the

U.S. Department of Veterans Affairs National Center (Blake et al., 1990). The CAPS, after
undergoing comprehensive validation (Weathers, Keane, & Davidson, 2001), has gained
widespread acceptance and is extensively utilized in clinical, research, and forensic contexts
(Elhai, Gray, Kashdan, & Franklin, 2005). Within the field of traumatic stress, it is widely
recognized as a fundamental criterion measure for assessing PTSD.

The CAPS serves multiple purposes, including making a diagnosis, determining a

lifetime diagnosis, or assessing PTSD symptoms over the previous week. It covers not only the
20 DSM-5 PTSD symptoms but also delves into the onset and duration of symptoms, subjective
distress, the impact of symptoms on social and occupational functioning, improvements in
symptoms since a previous CAPS assessment, overall response validity, overall PTSD severity,
and specifications for the dissociative subtype (depersonalization and derealization).

This interview was specifically developed for use by clinicians and clinical researchers
with expertise in PTSD and is typically administered in 45-60 minutes. It aligns closely with the
diagnostic criteria for PTSD outlined in the fifth edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-5) (U.S. Department of Veterans Affairs, 2018)."

Features of CAPS-5

Notable features of the CAPS include:

(a) assessment of all PTSD criteria plus associated features such as dissociation; (b) global
ratings of distress, impairment, response validity, symptom severity, and improvement since a
previous assessment; (c) both dichotomous (present/absent) and continuous ratings for individual
symptoms and overall disorder; (d) separate assessment of symptom frequency and intensity; (e)
behaviorally anchored prompts and rating scales; and (f) assessment of trauma-relatedness for
individual symptoms not inherently linked to the trauma (e.g., loss of interest, estrangement,
difficulty concentrating) (Weathers et al., 2018).
II. Theories where the CAPS-5 anchored

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is anchored in several

psychological and theoretical frameworks related to trauma, stress, and mental health. The
general theoretical foundations that underlie the use of CAPS-5, Here are the primary theories
where the CAPS-5 is anchored:

1. Lazarus and Folkman’s Transactional Model of tress and Coping

The CAPS-5 (Clinician-Administered PTSD Scale for DSM-5) is firmly rooted in

Lazarus and Folkman's Transactional Model of Stress and Coping, a foundational theory in the
field of stress psychology. According to this model, individuals do not merely react to external
stressors; instead, they engage in a cognitive appraisal process, evaluating whether a situation is
a threat, a challenge, or irrelevant. Subsequently, individuals assess their available coping
resources and strategies. The CAPS-5 effectively incorporates this theoretical framework into its
assessment approach. In clinical practice, the CAPS-5 enables clinicians to delve into the
cognitive appraisal process experienced by individuals who have encountered traumatic events.
Clinicians use CAPS-5 prompts and questions to explore patients' subjective experiences of
trauma, their perceptions of threat or challenge, and their emotional responses. Additionally, the
CAPS-5 indirectly assesses coping resources by evaluating how PTSD symptoms impact various
aspects of an individual's life, such as social and occupational functioning. This comprehensive
assessment aligns with Lazarus and Folkman's emphasis on understanding how individuals
appraise and cope with stressors. Ultimately, the CAPS-5 not only identifies PTSD symptoms
but also provides valuable insights into the coping processes of trauma survivors, facilitating the
tailoring of treatment interventions to individuals' unique appraisal styles and coping resources
(Lazarus & Folkman, 1984; Weathers, Keane, & Davidson, 2001).

2. Diagnostic Criteria (DSM-5)

The CAPS-5 (Clinician-Administered PTSD Scale for DSM-5) is explicitly anchored in

the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5). The DSM-5 is considered the authoritative resource for the classification
and diagnosis of mental health conditions, including post-traumatic stress disorder (PTSD)
((American Psychiatric Association, 2013)..
 The DSM-5 defines and specifies the criteria that must be met for an individual to be
diagnosed with PTSD. These criteria encompass the key symptoms and features of the disorder,
such as reexperiencing of traumatic events, avoidance of trauma-related stimuli, negative
alterations in mood and cognition, and hyperarousal. The CAPS-5 is designed to assess and
measure these specific symptoms in accordance with the DSM-5 criteria.

One of the primary strengths of the CAPS-5 is its ability to provide a structured and
standardized means of evaluating PTSD symptoms based on the precise criteria set forth in the
DSM-5 (Weathers, Keane, & Davidson, 2001). This alignment ensures that clinicians using the
CAPS-5 are conducting assessments that are consistent with the established diagnostic
guidelines, enhancing the validity and reliability of the diagnostic process.

III. Psychometric Properties of CAPS-5

The CAPS-5 has undergone rigorous psychometric evaluation, affirming its reliability
and validity as a clinical tool for assessing post-traumatic stress disorder (PTSD) symptoms
(Weathers et al., 2018). Key psychometric characteristics that bolster its credibility include the
following:

1. Reliability- The CAPS-5 exhibits commendable internal consistency, with robust Cronbach's
alpha coefficients for its individual items. This underscores the instrument's reliability in
consistently measuring the construct of PTSD symptomatology.

2. Test-Retest Reliability- Over time, the CAPS-5 maintains its stability, as demonstrated by
test-retest reliability analyses. This indicates the instrument's ability to yield consistent results
when administered on separate occasions, a crucial aspect of its reliability.

3. Inter-Rater Reliability- Inter-rater reliability is a pivotal consideration in clinical

assessments. The CAPS-5 impressively exhibits strong inter-rater reliability, affirming that
different clinicians can administer the tool and yield consistent outcomes.

4. Convergent Validity- The CAPS-5 aligns convincingly with other established measures of
PTSD symptomatology, affirming its convergent validity. Correlations with widely accepted self-
report measures like the PTSD Checklist for DSM-5 (PCL-5) provide strong evidence of the
CAPS-5's effectiveness in assessing PTSD symptoms.
 5. Criterion Validity- Anchored firmly in the diagnostic criteria of the DSM-5, the CAPS-5
assures criterion validity. Its close alignment with these diagnostic criteria establishes its efficacy
in measuring the presence and severity of PTSD symptoms, positioning it as a gold standard for
diagnosis.

6. Sensitivity and Specificity- The CAPS-5 boasts high sensitivity and specificity, a testament to
its accuracy in identifying individuals with PTSD while minimizing the risk of false-positive
diagnoses.

7. Standardizations- The CAPS-5's development involved a meticulous standardization process

to ensure its reliability and validity across different settings and populations. Detailed guidelines
and instructions for the administration and scoring of the CAPS-5 are provided in its manual.
This standardization ensures that clinicians and researchers can administer and interpret the
assessment consistently, regardless of their level of experience.

IV. CAPS-5 Revisions

All revisions for the CAPS-5 were drafted by the first author, in close consultation with
CAPS-5 coauthors. New CAPS-5 items to assess new DSM–5 symptoms were written in the
style of existing CAPS items and closely followed DSM–5 criterion language. All revisions
were reviewed by numerous experts in PTSD assessment, including the CAPS-5 authors,
colleagues at the National Center for PTSD, and the chair of and advisors to the
Trauma/Stress-Related and Dissociative Disorders Sub-Work Group (Friedman, 2013). The
revision process addressed key aspects of content validity (Haynes, Richard, & Kubany,
1995)—including item content, rating scale format, and instructions for standard
administration and scoring—and involved circulating drafts among the authors and other
trauma experts until consensus was reached regarding the final form of the interview.
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.

V. Diagnostic Criteria for PTSD based on CAPS-5

The diagnostic criteria for post-traumatic stress disorder (PTSD) based on the CAPS-5
(Clinician-Administered PTSD Scale for DSM-5) are aligned with the criteria outlined in the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To receive a
diagnosis of PTSD using the CAPS-5, an individual must meet the following criteria:

Criterion A: A traumatic Event (Open Ended Questions)

Criterion B: Re-experiencing symptoms (Questions 1-5)

Criterion C: Avoidance Symptoms (Questions 6-7)

Criterion D: Negative Alterations in cognition and mood (Questions 8-14)

Criterion E: Alterations in Arousal and reactivity (Questions 15-20)

Criterion F: Disturbance lasted at least a month (Questions 20-22)

Criterion G: Disturbance Causing Impairment (Questions 23-30)

VI. Scoring, and Interpretations

The CAPS-5 (Clinician-Administered PTSD Scale for DSM-5) rates the severity of
PTSD symptoms based on their frequency and intensity, except for items 8 (amnesia) and 12
(diminished interest), which are based on amount and intensity. Unlike previous versions,
CAPS-5 assigns a single severity score to each item, rather than separate scores for frequency
and intensity. Clinicians assess how often a symptom occurred in the past month or the
percentage of time it happened. Intensity is measured on a four-point ordinal scale from
Minimal to Extreme, representing the typical strength of a symptom occurrence. Severity, on
the other hand, combines both intensity and frequency. To interpret the ratings, Minimal
intensity corresponds to Mild/subthreshold severity, Clearly Present to Moderate/threshold
severity, Pronounced to Severe/markedly elevated severity, and Extreme to
Extreme/incapacitating severity. This approach streamlines the assessment process for
clinicians.

The five-point CAPS-5 symptom severity rating scale is used for all symptoms. Rating
scale anchors should be interpreted and used as follows:

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 DSM5 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 well above
the 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
the threshold. The problem is pervasive, unmanageable, and overwhelming, and would be
a high-priority target for intervention.
 To diagnose PTSD using the CAPS-5, it's important to ensure that a symptom not only
aligns with the DSM-5 criteria but is also functionally related to the traumatic event. Items 1-
8 and 10 (reexperiencing, effortful avoidance, amnesia, and blame) are inherently connected
to the traumatic event. For the other items, assess their trauma-relatedness (TR) using a rating
scale:
Definite- The symptom can be clearly attributed to the traumatic event. This is evident
either through a significant change from pre-trauma functioning or the respondent's
confident attribution to the traumatic event.
Probable- The symptom is likely related to the traumatic event, but a clear-cut
connection can't be established. This rating is used when there's some change from pre-
trauma functioning, but it's not as explicit as in the "Definite" rating. The respondent
might attribute the symptom to the traumatic event but with less confidence. Additionally,
there might be a functional relationship between the symptom and inherently trauma-
linked symptoms, such as reexperiencing symptoms.
Unlikely- The symptom can be attributed to a cause other than the traumatic event. This
is evident either through a clear functional link to another cause or the respondent
confidently attributing it to another cause and denying a link to the traumatic event. This
rating should only be used when strong evidence points to a cause other than the
traumatic event. Symptoms with an "Unlikely" rating should not be considered for a
PTSD diagnosis or included in the total CAPS-5 symptom severity score.

CAPS-5 total symptom severity score is calculated by summing severity scores for items 1-20.
NOTE: Severity scores for the two dissociation items (29 and 30) should NOT be included in the
calculation of the total CAPS-5 severity score.

CAPS-5 symptom cluster severity scores- The CAPS-5 computes severity scores for
symptom clusters in accordance with DSM-5 by totaling the individual item severity scores
within each specific cluster. To elaborate, the severity score for Criterion B (reexperiencing)
encompasses the cumulative severity scores for items 1 to 5. Likewise, Criterion C
(avoidance) involves the summation of items 6 and 7, while Criterion D (negative alterations
in cognitions and mood) is derived from adding up scores for items 8 to 14. Lastly, Criterion
E (hyperarousal) entails summing the individual item severity scores for items 15 to 20.
 Additionally, a symptom cluster score for dissociation can be calculated by summing the
scores of items 29 and 30.

PTSD diagnostic status- To diagnose PTSD using the CAPS-5, symptoms are categorized as
Present or Absent based on their severity scores. A symptom is considered Present if its
severity score is rated as 2=Moderate/threshold or higher. For items 9 and 11-20, a trauma-
relatedness rating of Definite or Probable is also required for a symptom to be considered
Present. The DSM-5 diagnostic rule necessitates at least one symptom from Criterion B, one
from Criterion C, two from Criterion D, and two from Criterion E. Criteria F requires the
disturbance to last at least one month, and Criterion G mandates clinically significant distress
or functional impairment, indicated by a severity rating of 2=Moderate or higher on items 23-
25. On contrary, the "PAST WEEK version" of the CAPS-5 should only assess PTSD
symptom severity over the past week and is not used for diagnosis.

VII. Sample of CAPS-5 Test

In order to better illustrate the assessment process, a sample test has been included in this
paper. The sample test provided in this paper is based on the Clinician-administered PTSD
scale for DSM-5 (CAPS-5) by Weather et, al. 2015, and is included for illustrative purposes
only. No copyright infringement or reproduction of the original material is intended. This
sample test has been adapted and presented here to demonstrate the testing, scoring, and
interpretation process of CAPS-5.
VIII. References:

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Elhai JD, Gray MJ, Kashdan

TB, Franklin CL. Which
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commonly used to assess
traumatic
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Stress. 2005;18:541–545.

Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. Springer.

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and
description. Death Studies, 23(3), 197-224.

Va.gov: Veterans Affairs. Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). (2018,
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Weathers FW, Keane TM, Davidson JRT. Clinician-administered PTSD scale: A review of the first ten
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Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2018). The
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Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., Keane, T. M., &
Marx, B. P. (2018, March). The clinician-administered PTSD scale for DSM-5 (CAPS-5):
Development and initial psychometric evaluation in military veterans. Psychological assessment.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805662/

Weathers, F. W., Keane, T. M., & Davidson, J. R. T. (2001). Clinician-Administered PTSD Scale: A
review of the first ten years of research. Depression and Anxiety, 13(3), 132-156.

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). [Assessment] Available from
www.ptsd.va.gov.