B. Assessment Of Trauma Exposure

RECOMMENDATION

1. Assessment of the trauma exposure should include:
   • History of exposure to traumatic event(s)
   • Nature of the trauma
   • Severity of the trauma
   • Duration and frequency of the trauma
   • Age at time of trauma
   • Patient’s reaction at time of trauma (e.g., helplessness, horror, and fear)
   • Existence of multiple traumas.
2. When assessing trauma exposure the clinician must consider the patient’s ability to tolerate the recounting of traumatic material, since it may exacerbate PTSD symptoms.
3. The assessment should be performed cautiously, especially in situations where the trauma source is still present and the patient perceives himself or herself to be in danger.

DISCUSSION

Trauma assessment includes a careful examination of the trauma, including the nature of the patient's involvement in the traumatic event, the patient's thoughts and feelings about what he or she did or did not do, the effect of the trauma on the patient's life and experience of self and others, and an assessment of the patient's trauma symptoms. The history also should include an assessment of prior stressful life events; coping style; ego resources and self capacities; cognitive functioning; psychiatric history; medical, family, social, and occupational history; and cultural and religious background. This background is necessary to establish an appropriate treatment plan. For example, if the individual does not feel safe in his or her current living situation, issues concerning safety need to be addressed first. Alternatively, if the individual has a history of childhood abuse and has learned to use dissociation to protect the self, treatment will need to focus on helping the trauma victim manage his or her tendency to dissociate under stress. The repeatedly-traumatized individual may also need to work through earlier childhood traumas as well as the more recent event.