Richard A. Bryant
There is significant change in acute stress reactions in the weeks after exposure to a traumatic event, which raises challenges for assessing the responses in the acute posttraumatic period. This chapter reviews the assessment tools and strategies that are appropriate in the acute period. It focuses initially on acute stress disorder (ASD) as a description of acute posttraumatic stress and as a predictor of subsequent PTSD. Psychometrically-validated scales are reviewed for both diagnostic and symptom responses in the acute period, with a critique of the limited ability of these measures to identify most people who are at high risk for subsequent PTSD. Finally, this chapter identifies mechanisms that may enhance our ability to identify maladaptive responses in the acute phase, and specific populations that need particular attention in the immediate period following trauma exposure. The weeks following exposure to a traumatic event are often characterized by considerable distress, fluctuating emotions, and changing environmental factors. This lack of emotional and contextual stability raises significant challenges for assessment of psychological states shortly after trauma. This chapter aims to provide an overview of assessment of psychological responses in the weeks after trauma. It commences with a review of the current evidence about the nature of acute posttraumatic stress reactions and discusses the different goals of assessment at this stage. Established psychometric instruments are then reviewed, including structured clinical interviews, self-report measures, and other tools relevant to acute reactions. The review then turns to other factors that can be assessed, including cognitive and biological factors, occurring in the acute posttraumatic period. Finally, the chapter outlines other procedural issues that need to be considered when assessing trauma survivors in the acute phase.
Ken Winters, Tamara Fahnhorst, Andria Botzet, Randy Stinchfield, and Ali Nicholson
This chapter addresses several assessment and measurement issues relevant to adolescent drug abuse. Both researchers and clinicians working with youth suspected of problems associated with drug involvement are considered as the following topics are discussed: principles of assessment, validity of self-report, clinical domains of interest, instrumentation, clinical considerations when assessing youth, and assessing treatment outcome. Despite some research gaps, the field consists of several psychometrically sound screening and comprehensive assessment tools to assist researchers and clinicians when measuring drug use, drug problems, symptoms of substance use disorders, and behavioral problems that commonly coexist with drug involvement. Future research needs are also discussed, including the need for more psychometric data on sub-populations of young people defined by age and ethnicity/race.
Dustin B. Hammers, Kevin Duff, and Gordon J. Chelune
This chapter describes methods of evaluating cognitive change over time using evidence-based practices in the field of clinical neuropsychology. While doing so, a description of cognitive changes during the ‘normal’ ageing process is undertaken, followed by a brief review of cognitive trajectories for a few syndromes associated with abnormal decline. A discussion of the practice of clinical neuropsychology ensues, accompanied by concerns arising when using traditional single time-point assessments. The benefits of and challenges to using serial assessments are also discussed, as well as a basic review of the statistical methods available to identify reliable change over time. The chapter concludes with proposed research directions for the field to better tailor the use of cognitive trajectories to monitor predicted decline in the individual patient.
Obsessive compulsive disorder (OCD) is a complex and debilitating disorder that has a high degree of comorbidity and functional impairment, and significant impact on the family. The purpose of this chapter is to provide a brief overview of comorbidity, family, insight, and quality of life issues, and to review assessment and treatment implications of those issues. Measures for assessing relevant constructs are described.
Douglas K. Snyder, Richard E. Heyman, and Stephen N. Haynes
Couple distress has a high prevalence as well as high comorbidity with a broad range of emotional, behavioral, and physical health problems. Marriage and relationship problems also influence individuals' response to treatment for a wide range of psychological disorders. Hence, clinicians need to be skilled in conducting clinical assessment involving relationships in order to provide effective interventions, whether working primarily with individuals, couples, or the broader family system. This article first introduces brief screening measures and clinical methods for diagnosing couple distress in clinical as well as research applications. It then conceptualizes and assesses couple distress for the purpose of planning and evaluating treatment. The article also reviews empirical findings regarding behavioral, cognitive, and affective components of couple distress, and specific techniques derived from clinical interviews, behavioral observations, and self-reports. Finally, it considers emerging technologies for assessing intimate relationships and makes recommendations for future research.
Jessica R. Grisham and Alishia D. Williams
The assessment of hoarding has evolved over the past two decades to more appropriately capture its key features and associated phenomena. The authors describe a comprehensive and multimethod approach to assessment, which includes questionnaires, pictorial assessment, interview-based measures, behavioral tasks, and the incorporation of reports of family members and clinicians. It begins by reviewing self-report and interview-based measures of hoarding symptoms and providing relevant psychometric information and clinical-cut off scores. It then provides information regarding the assessment of clinical features commonly associated with hoarding, such as hoarding-related beliefs, excessive acquisition, and comorbid psychopathology. It concludes the chapter by noting specific clinical considerations when assessing an individual with hoarding problems and suggesting future directions in the assessment of hoarding, including the incorporation of more standardized behavioral measures of discarding, acquiring, and categorizing.
Nicole M. Dorfan and Sheila R. Woody
This chapter describes methods and tools for assessing obsessive compulsive disorder (OCD). The chapter outlines the purposes of assessment and discusses special challenges presented by OCD, such as shame associated with socially unacceptable obsessional content. Several types of assessment tools are discussed, including structured diagnostic interviews, semistructured clinician interviews to assess OCD symptom profile and severity, self-report instruments, behavioral assessment and self-monitoring, assessment of appraisals and beliefs relevant to OCD, and functional impairment. The importance of linking assessment findings to an evidence-based treatment plan is discussed.
Michelle J. Bovin and Frank W. Weathers
Posttraumatic stress disorder (PTSD) is a serious and prevalent mental disorder that poses a number of significant challenges for accurate assessment and diagnosis. In this chapter we describe some of the most widely used PTSD assessment tools for adult trauma survivors, including structured interviews, self-report measures, and psychophysiological methods. We also discuss several key issues in PTSD assessment, including identifying an index traumatic event for symptom inquiry, linking symptoms to the index event, and detecting exaggerated symptom reporting. We conclude with a brief discussion of future directions for research on PTSD assessment.
Darren W. Holowka and Brian P. Marx
Previous research has shown that PTSD is associated with impairments in functioning across a variety of domains and decrements in quality of life. In this chapter, we review the literature on the assessment of PTSD-related impairments in functioning and quality of life. We first discuss the importance of assessing PTSD-related impairments in quality of life and functioning. We then review some important methodological concerns related to the assessment of these constructs. Finally, we review some of the most commonly used assessment tools and discuss recent efforts to develop and validate a new assessment tool to assess PTSD-related functional impairment.
Sonja March, Alexandra De Young, Belinda Dow, and Justin Kenardy
The literature concerning the assessment of posttrauma reactions is well developed for adults, but this is not so for children and adolescents, especially young children. This chapter covers some key trauma-assessment issues in the child and adolescent population, which includes derivation and validation problems, the influence of developmental factors, applicability of current diagnostic classification, and the use of multiple informants. The range of available assessment measures is then reviewed, including semi-structured and self-report measures of posttraumatic stress disorder, acute stress disorder, and dissociation. Available screening measures and physiological measures are also reviewed. Directions for future work in this area are made.
Michael S. McCloskey, Mitchell E. Berman, and Kurtis Noblett
Intermittent explosive disorder (IED), a DSM-IV-TR disorder characterized by significant acts of aggression and violence, is being increasingly recognized as a prevalent and chronic disorder. Given the personal, social, and economic costs associated with IED, there is a clear need for well-validated assessment measures and efficacious treatments. However, there are currently no published, well-validated diagnostic measures of IED. With regard to treatment, preliminary evidence from a few randomized clinical trials suggests that selective serotonin reuptake inhibitors and cognitive behavioral psychotherapy may be effective in treating IED. However, more research is needed before either can be considered an empirically supported treatment for IED. In this chapter, we discuss (1) challenges in developing reliable and valid assessments for IED and (2) issues relevant to developing and testing psychological and pharmacological treatment interventions for IED.
Jon E. Grant, Brian L. Odlaug, and Suck Won Kim
Kleptomania, a disabling impulse control disorder, is characterized by repetitive and uncontrollable theft of items that are of little if any use. Kleptomania often goes undiagnosed or is misdiagnosed as a mood disorder, obsessive-compulsive disorder, or a substance use disorder. Unlike typical shoplifters, individuals with kleptomania steal for symptomatic relief rather than personal gain. Although the etiology of kleptomania is unknown, various biological and psychosocial theories may explain why some individuals develop kleptomania. Although cognitive behavioral therapy has shown early promise in treating kleptomania in case reports, the only controlled data for treatment involve the use of the opioid antagonist naltrexone.
As gambling becomes more popular, more people will be exposed to it; thus, the prevalence of and demand for gambling-related treatments are expected to increase. Pathological gambling (PG) is the most severe level of gambling compromise, characterized by unrestrained gambling to the point of financial and psychosocial harm. Classified among the impulse control disorders, PG resembles other addictive disorders. A host of scales for screening and diagnosing PG are available for both the specialist and the general practitioner. The diagnosis of PG, like that of other addictions, is based upon signs of loss of control over the target behavior (i.e., gambling), dose escalation (increasing amounts wagered to get the same excitement as in previous bets), withdrawal-like symptoms, psychosocial harm, persistent desire, and persistent betting despite the negative consequences. Its treatment requires thorough assessment of psychiatric related conditions, motivational intervention, gambling-focused psychotherapy, relapse prevention, and support for maintenance of treatment gains. Psychopharmacological tools to treat craving and gambling recurrence are an incipient but promising field.
Jedidiah Siev, Hannah E. Reese, Kiara Timpano, and Sabine Wilhelm
Pathological skin picking (PSP) refers to chronic skin picking or scratching that causes tissue damage and distress. It is a heterogeneous category of behaviors and may be manifest in the context of various psychological disorders. This chapter presents an overview of the empirical literature on the assessment and treatment of PSP, including (1) a cognitive-behavioral model as heuristic for conceptualizing treatment, (2) assessment tools, (3) a review of the pharmacological and psychosocial treatment outcome literatures, (4) cognitive-behavioral treatment techniques, and (5) future directions. The chapter is intended to introduce the clinician to the assessment and psychological tools used to treat PSP, as well as to provide impetus to advance research in this understudied domain.
Research over the last decade has identified Internet addiction as a new and often unrecognized clinical disorder that impacts a user’s ability to control online use to the extent that it can cause relational, occupational, and social problems. Symptoms of problem Internet use are compared to criteria used to diagnose other addictions. In particular, pathological gambling is compared to problematic Internet use because of overlapping criteria. This chapter describes the diagnostic and treatment implications of the disorder. As technology is used with great frequency, detection and diagnosis of Internet addiction is often difficult. Symptoms may be masked by legitimate use of the Internet, and clinicians may overlook asking questions about technology use because problem Internet use is still a new and often unrecognized condition. This chapter outlines diagnostic conceptualizations of problem Internet use along with assessment and treatment considerations and the newest inclusion in the DSM-5 for Internet Gaming Disorder.
Jon E. Grant and Brian L. Odlaug
Pyromania, also referred to as pathological fire setting, is a disorder defined by the deliberate and purposeful fire setting that has occurred on more than one occasion and that cannot be attributed to another psychiatric disorder. Although juvenile or adolescent fire-setting behavior or match play is a fairly common occurrence, clinical pyromania is a rare disorder associated with shame and embarrassment, significant psychosocial dysfunction, and legal consequences. Case reports and small controlled clinical trials have reported the successful treatment of fire-setting behavior through both pharmacotherapeutic and psychotherapeutic means. Pyromania, however, is a largely misunderstood, unrecognized, and untreated disorder.
Alexis K. Matusiewicz, Brady Reynolds, and Carl W. Lejuez
This chapter provides a review of measures used to assess the impulse control disorders (ICDs) included in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) and those proposed for DSM-V, as well as measures used to assess the related psychological construct of impulsivity implicated in the development and maintenance of ICDs. We first present instruments used to assess ICDs including diagnostic interviews, as well as self-report and clinician-rated measures of symptom severity. Second, we present self-report and behavioral measures of impulsivity. The review includes theoretical rationales, procedural details, and empirical evidence, including detailed psychometric data for each measure to provide a comprehensive guide to the assessment of ICDs and the construct of impulsivity.
Jennifer L. Harrington and Martin M. Antony
Psychological assessment of anxiety disorders is important in both clinical and research settings. This chapter reviews the various purposes of assessment, discusses issues related to diagnostic assessment, and highlights other areas that are relevant in the evaluation process (e.g., anxiety triggers, avoidance behavior, interference, psychosocial influences, etc.). A variety of assessment methods is discussed, including clinical interviews, behavioral tests, psychophysiological measurement, and behavioral diaries, and the use of multimethod assessment strategies is encouraged. A brief overview of empirically supported assessment measures is also provided.
T. Mark Harwood and Larry E. Beutler
Pretreatment planning is an essential element in psychotherapy. Constraints imposed by managed care, efficiency-of-treatment/cost-effectiveness issues, and increased likelihood of change and increased magnitude of change are obvious justifications for the provision of individualized and comprehensive pretreatment assessment. Relatedly, quality pretreatment assessment is essential for accurate patient–treatment matching. In this vein, systematic treatment selection, prescriptive psychotherapy, systematic treatment, and Innerlife are variants of an overriding empirically supported model of patient–treatment matching. More specifically, they employ accurate, comprehensive pretreatment assessment to help guide the clinician in the selection and matching of specific psychotherapeutic strategies and principles. Questions regarding diagnosis, prognosis, current level of functioning, most effective treatment, and causation/maintenance are answerable through an evaluation of relevant patient predisposing variables. While there are many qualities of problems that vary as a function of specific situations and circumstances, three appear to be of major importance to the differential assignment of treatment: patient expectations, subjective distress, and functional impairment.
E. David Klonsky and Stephen P. Lewis
This chapter provides guidance regarding the assessment of nonsuicidal self-injury (NSSI). Assessors are encouraged to enhance rapport through “respectful curiosity” and a “low-key, dispassionate demeanor.” The assessment should cover several aspects of NSSI, including personal history of NSSI (e.g., methods, frequency, medical severity), social history of NSSI (e.g., roles of peers, family members), the contextual features (e.g., environmental, cognitive, affective, biological factors), concomitant risky behaviors (e.g., substance use), the functions of NSSI (e.g., affect regulation, other intrapersonal and social functions), and suicide risk. When feasible, assessors should utilize valid instruments to aid in the assessment of NSSI. Valid omnibus measures include the Suicide Attempt Self-Injury Interview (SASII; Linehan, Comtois, Brown, Heard, & Wagner, 2006) and the Self-Injurious Thoughts and Behaviors Interview (SITBI; Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006). Valid functional measures include the Functional Assessment of Self-Mutilation (FASM; Lloyd-Richardson, Kelley, & Hope, 1997) and the Inventory of Statements About Self-Injury (ISAS; Klonsky & Glenn, 2009).