On the CAPS-5, a few specific strategies to consider in judging the validity of a CAPS-5 assessment include:

1. Critically evaluate clients who endorse nearly all items of the CAPS with high severity ratings, as they may be overstating symptoms (though they may still have PTSD). Anchoring items in behavioral examples, rather than just the clients’ reports of subjective distress, can help separate exaggeration from true extreme cases.
2. Similarly, rely on behavioral examples and observation rather than self-report to identify symptom-level presentations despite underreporting. For example, an interviewee may indicate his nightmares are “not bad” but indicates that he loses more than 2 hours of sleep each night because of them. This underreporting may be the result of stoicism, or may be because he is used to this disturbance.
3. Complete the CAPS-5 validity assessment question regarding the extent to which assessment results are compromised by impaired mental status or dissimulation. A “2” or greater is cause for concern; it suggests that you are questioning whether the CAPS-5 PTSD diagnosis is reliable.

A multimethod approach, where results are obtained by methods that rely on multiple sources of information, is helpful in addressing response bias concerns of all types. In situations where concerns about exaggeration or outright malingering for secondary gain purposes may be pertinent (disability evaluations or personal injury claims), it is important to look at all available information before concluding that malingering is a possibility.

It may also be useful to include measures with response validity indicators, such as the Minnesota Multiphasic Personality Inventory – Second Edition (MMPI-2) and Personality Assessment Inventory (PAI), or specialized measures designed to detect inconsistent or bias responding, such as the Structured Interview of Reported Symptoms (SIRS). Multimethod assessment is also useful when there are concerns about the underreporting of symptoms due to stigma or the need to seem healthy; information from multiple measures and sources can help determine if the interviewee is being less than forthcoming with his or her difficulties.