a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.
b Department of Psychology, Northern Illinois University , DeKalb , IL , USA.
Anxiety Stress Coping. 2019 Sep;32(5):559-567. doi: 10.1080/10615806.2019.1638682. Epub 2019 Jul 4.
Standard practice in assessing and diagnosing posttraumatic stress disorder (PTSD) entails identifying a single "worst" index event as the basis for symptom inquiry. Determining a single event can be challenging for clinicians and clients when multiple traumas are considered equally distressing. Additionally, it can be difficult to distinguish potential index events based on distress given the cumulative effect of repeated trauma exposure. This calls for the development of approaches that build on existing selection methods (e.g., worst event method). In this article, we propose an innovative approach for identifying and measuring index events that utilizes the construct of event centrality to expand the parameters by which index events are selected. Event centrality assesses the degree to which traumatic events are perceived as integral to one's personal identity and worldviews. Given its role in the etiology and maintenance of PTSD symptoms, this construct also approximates the emotional impact of trauma. Incorporating validated measures of event centrality into PTSD assessments would provide an objective strategy for identifying index events in a way that may increase the reliability of diagnosis. Our proposed strategy may also have a positive impact on the therapeutic process and treatment outcomes.
评估和诊断创伤后应激障碍（PTSD）的标准做法包括确定一个单一的“最严重”事件作为症状询问的基础。当考虑到多个创伤同样令人痛苦时，临床医生和患者确定单一事件可能具有挑战性。此外，鉴于反复创伤暴露的累积效应，基于痛苦来区分潜在的指标事件可能很困难。这需要开发基于现有选择方法（例如，最严重事件方法）的方法。在本文中，我们提出了一种创新的方法来识别和测量指标事件，该方法利用事件中心性的结构来扩展选择指标事件的参数。事件中心性评估创伤事件被视为个人身份和世界观不可或缺的程度。鉴于其在 PTSD 症状的病因学和维持中的作用，该结构也近似于创伤的情绪影响。将经过验证的事件中心性测量纳入 PTSD 评估中，将为以可能提高诊断可靠性的方式确定指标事件提供一种客观策略。我们提出的策略也可能对治疗过程和治疗结果产生积极影响。
