Criterion B1, captures recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) that can be cued or un-cued.

In coding this, and other, CAPS-5 items, it is always useful to ask the interviewee about behavioral manifestations of the symptom. For this item, a behavioral manifestation of the intensity of the symptom can be the amount of time it takes the person to put the thought out of their mind and think about something else. Respondents often describe their symptoms in more vague terms, e.g, reporting that they can “sometimes” put the memory out of their mind and that it is “very bothersome”. Asking about specific time frames and using these in concert with respondents’ reported distress and clinical observation can therefore be helpful for scoring the item objectively. Heuristics that may be used to help coding are as follows: 1) clearly present = 5-15 minutes, 2) pronounced = 30-60 minutes, 3) extreme = more than 60 minutes. However, we strongly caution against reifying these suggestions for coding. Clinicians should always use their best judgment when coding an individual’s response to questions.

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Criterion B2 captures recurrent distressing dreams in which the content and/or affective tone of the dream are related to the traumatic event(s).

A person must remember dream content and/or affective tone to reach a symptomatic level on this CAPS item. If they endorsed remembering having unpleasant dreams when they got up in the morning, but not having been woken up by these dreams in the night, this would generally indicate a “minimal” intensity score. The CAPS-5 key for this item indicates that nightmares with Clearly Present intensity are typically associated with less than 1 hour of sleep loss, whereas nightmares with Pronounced intensity are typically associated with more than 1 hour of sleep loss. Further heuristics that may be used to help coding are as follows: 1) clearly present = 15 minutes – 1 hour sleep loss, 2) pronounced = 1-3 hours of sleep loss, 3) extreme = more than 3 hours of sleep loss. However, the severity is not determined just by amount of sleep loss, but also by distress upon awakening and residual effects. Further, we strongly caution against reifying these suggestions for coding. Clinicians should always use their best judgment when coding an individual’s response to questions.

If you are not sure if the dream is trauma related, ask the respondent. If they are not sure, then ask about how they felt during the dream, and if it’s reminiscent of how they felt at the time of the trauma.

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Criterion B3 captures dissociative reactions, or flashbacks, in which the person feels or acts as if the traumatic event(s) were recurring.

Such reactions may occur on a continuum, with the most extreme expression of a flashback involving a complete loss of awareness of present surroundings. The flashback may be very brief and still be of clearly present intensity if the respondent loses track of where they are and truly believes they are back at the time of the trauma.

Flashbacks are a low base rate item. The person needs to convince you it’s a flashback. To be coded, they must think they’re back in the traumatic experience, and it cannot be due to drugs, medicine, or alcohol.

If the person only believes they are back at the time of the trauma, actually reliving it, immediately upon awakening from a dream, count it as part of the nightmare (B2) and NOT as a flashback (B3).

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Criterion B4 captures intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s), such as people, things (e.g., guns), conversations, noises, thoughts, or feelings.

There is overlap between this item and B1 (recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) that can be cued or un-cued). However, unlike for B1, for B4, the distress MUST be cued by a trauma reminder.

In general, it can be helpful to ground your rating of this item’s intensity in the person’s behavioral response (e.g., the amount of time it takes for the person to calm down). Heuristics that may be used to help coding are as follows: 1) clearly present = 5-15 minutes, 2) pronounced = 30-60 minutes, 3) extreme = more than 60 minutes. However, we strongly caution against reifying these suggestions for coding. Clinicians should always use their best judgment when coding an individual’s response to questions. For example, even if the distress lasts for 10 minutes, if the reaction is more substantial (during the 10-minute period, the respondent is screaming and crying and runs out of a building), you would increase your intensity rating based on these other manifestations.

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Criterion B5 captures marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). You will be looking for panic-type reactions with this item, with panic attacks as the extreme score example. Heuristics that may be used to help coding are as follows: 1) clearly present = 5-15 minutes, 2) pronounced = 30-60 minutes, 3) extreme = more than 60 minutes. However, as discussed above, we strongly caution against reifying these suggestions for coding. Clinicians should always use their best judgment when coding an individual’s response to questions. Return to list