Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
Past Month Version
Version date: 13 April 2018
Reference: Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2015). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) – Past Month [Measurement instrument]. Available from https://www.ptsd.va.gov/
URL: https://www.ptsd.va.gov/professional/ assessment/adult-int/caps.asp
Note: This is a fillable form. You may complete it electronically.
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CAPS-5 Past Month
Standard administration and scoring of the CAPS-5 are essential for producing reliable and valid scores and diagnostic decisions. The CAPS-5 should be administered only by qualified interviewers who have formal training in structured clinical interviewing and differential diagnosis, a thorough understanding of the conceptual basis of PTSD and its various symptoms, and detailed knowledge of the features and conventions of the CAPS-5 itself.
1. Identify an index traumatic event to serve as the basis for symptom inquiry. Administer the Life Events Checklist and Criterion A inquiry provided on p. 4, or use some other structured, evidence-based method. The index event may involve either a single incident (e.g., “the accident”) or multiple, closely related incidents (e.g., “the worst parts of your combat experiences”).
2. Read prompts verbatim, one at a time, and in the order presented, EXCEPT:
a. Use the respondent’s own words for labeling the index event or describing specific symptoms.
b. Rephrase standard prompts to acknowledge previously reported information, but return to verbatim phrasing as soon as possible. For example, inquiry for item 20 might begin: “You already mentioned having problem sleeping. What kinds of problems?”
c. If you don’t have sufficient information after exhausting all standard prompts, follow up ad lib. In this situation, repeating the initial prompt often helps refocus the respondent.
d. As needed, ask for specific examples or direct the respondent to elaborate even when such prompts are not provided explicitly.
3. In general, DO NOT suggest responses. If a respondent has pronounced difficulty understanding a prompt it may be necessary to offer a brief example to clarify and illustrate. However, this should be done rarely and only after the respondent has been given ample opportunity to answer spontaneously.
4. DO NOT read rating scale anchors to the respondent. They are intended only for you, the interviewer, because appropriate use requires clinical judgment and a thorough understanding of CAPS-5 scoring conventions.
5. Move through the interview as efficiently as possible to minimize respondent burden. Some useful strategies:
a. Be thoroughly familiar with the CAPS-5 so that prompts flow smoothly.
b. Ask the fewest number of prompts needed to obtain sufficient information to support a valid rating.
c. Minimize note-taking and write while the respondent is talking to avoid long pauses.
d. Take charge of the interview. Be respectful but firm in keeping the respondent on task, transitioning between questions, pressing for examples, or pointing out contradictions.
CAPS-5 Past Month (13 April 2018) National Center for PTSD
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1. As with previous versions of the CAPS, CAPS-5 symptom severity ratings are based on symptom frequency and intensity, except for items 8 (amnesia) and 12 (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 for each item that were either summed to create a symptom severity score or combined in various scoring rules to create a dichotomous (present/absent) symptom score. Thus, on the CAPS-5 the clinician combines information about frequency and intensity before making a single severity rating. Depending on the item, frequency is rated as either the number of occurrences (how often in the past month) or percent of time (how much of the time in the past month). Intensity is rated on a four-point ordinal scale with ratings of Minimal, Clearly Present, Pronounced, and Extreme. Intensity and severity are related but distinct. Intensity refers to the strength of a typical occurrence of a symptom. Severity refers to the total symptom load over a given time period, and is a combination of intensity and frequency. This is similar to the quantity/frequency assessment approach to alcohol consumption. In general, intensity rating anchors correspond to severity scale anchors described below and should be interpreted and used in the same way, except that severity ratings require joint consideration of intensity and frequency. Thus, before taking frequency into account, an intensity rating of Minimal corresponds to a severity rating of Mild / subthreshold, Clearly Present corresponds with Moderate / threshold, Pronounced corresponds with Severe / markedly elevated, and Extreme corresponds with Extreme / incapacitating.
2. 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 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 well 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.
3. In general, make a given severity rating only if the minimum frequency and intensity for that rating are both met. However, you may exercise clinical judgment in making a given severity rating if the reported frequency is somewhat lower than required, but the intensity is higher. For example, you may make a severity rating of Moderate / threshold if a symptom occurs 1 X month (instead of the required 2 X month) as long as intensity is rated Pronounced or Extreme (instead of the required Clearly Present). Similarly, you may make a severity rating of Severe / markedly elevated if a symptom occurs 1 X week (instead of the required 2 X week) as long as the intensity is rated Extreme (instead of the required Pronounced). If you are unable to decide between two severity ratings, make the lower rating.
CAPS-5 Past Month (13 April 2018) National Center for PTSD
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4. You need to establish that a symptom not only meets the DSM-5 criterion phenomenologically, but is also functionally related to the index traumatic event, i.e., started or got worse as a result of the event. CAPS-5 items 1-8 and 10 (reexperiencing, effortful avoidance, amnesia, and blame) are inherently linked to the event. Evaluate the remaining items for trauma-relatedness (TR) using the TR inquiry and rating scale. The three TR ratings are:
a. Definite = the symptom can clearly be attributed to the index trauma, because (1) there is an obvious change from the pre-trauma level of functioning and/or (2) the respondent makes the attribution to the index trauma with confidence.
b. Probable = the symptom is likely related to the index trauma, but an unequivocal connection can’t be made. Situations in which this rating would be given include the following: (1) there seems to be a change from the pre-trauma level of functioning, but it isn’t as clear and explicit as it would be for a Definite; (2) the respondent attributes a causal link between the symptom and the index trauma, but with less confidence than for a rating of Definite; (3) there appears to be a functional relationship between the symptom and inherently trauma-linked symptoms such as reexperiencing symptoms (e.g., numbing or withdrawal increases when reexperiencing increases).
c. Unlikely = the symptom can be attributed to a cause other than the index trauma because (1) there is an obvious functional link with this other cause and/or (2) the respondent makes a confident attribution to this other cause and denies a link to the index trauma. Because it can be difficult to rule out a functional link between a symptom and the index trauma, a rating of Unlikely should be used only when the available evidence strongly points to a cause other than the index trauma. NOTE: Symptoms with a TR rating of Unlikely should not be counted toward a PTSD diagnosis or included in the total CAPS-5 symptom severity score.
5. 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.
6. CAPS-5 symptom cluster severity scores are calculated by summing the individual item severity scores for symptoms contained in a given DSM-5 cluster. Thus, the Criterion B (reexperiencing) severity score is the sum of the individual severity scores for items 1-5; the Criterion C (avoidance) severity score is the sum of items 6 and 7; the Criterion D (negative alterations in cognitions and mood) severity score is the sum of items 8-14; and the Criterion E (hyperarousal) severity score is the sum of items 15-20. A symptom cluster score may also be calculated for dissociation by summing items 29 and 30.
7. PTSD diagnostic status is determined by first dichotomizing individual symptoms as Present or Absent, then following the DSM-5 diagnostic rule. A symptom is considered present only if the corresponding item severity score is rated 2=Moderate / threshold or higher. Items 9 and 11-20 have the additional requirement of a trauma- relatedness rating of Definite or Probable. Otherwise a symptom is considered absent. The DSM-5 diagnostic rule requires the presence of least one Criterion B symptom, one Criterion C symptom, two Criterion D symptoms, and two Criterion E symptoms. In addition, Criteria F and G must be met. Criterion F requires that the disturbance has lasted at least one month. Criterion G requires that the disturbance cause either clinically significant distress or functional impairment, as indicated by a rating of 2=Moderate or higher on items 23-25.
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