Child PTSD Symptom Scale (CPSS)

Abstract

The Child PTSD Symptom Scale (CPSS) is an internationally recognized, standardized instrument developed by Dr. Edna B. Foa and colleagues to evaluate the presence and severity of posttraumatic stress disorder (PTSD) symptomatology and associated functional impairment in children and adolescents aged 8 to 18 years. Rooted in the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the instrument translates complex clinical constructs into developmentally sensitive, accessible language appropriate for pediatric populations. The CPSS comprises 26 discrete items partitioned into two primary sections: Part 1 consists of 17 symptom items mapping directly onto the three diagnostic symptom clusters of DSM-IV PTSD—Re-experiencing/Intrusion (5 items), Avoidance/Numbing (7 items), and Hyperarousal (5 items)—rated on a 4-point Likert frequency scale ranging from 0 (“Not at all or only at one time”) to 3 (“5 or more times a week / almost always”). Part 2 consists of 7 dichotomous items (0 = Absent, 1 = Present) evaluating trauma-related functional impairment across critical daily life domains, including academic performance, peer relationships, familial functioning, and general wellbeing.

Extensive psychometric investigations have established that the CPSS possesses robust measurement properties across diverse clinical, school, and post-disaster settings. The total symptom severity scale (ranging from 0 to 51) demonstrates high internal consistency (Cronbach’s alpha typically ranging between .89 and .92) and strong test-retest reliability across 1- to 4-week test intervals (coefficients ranging from .84 to .87). Convergent validity is evidenced by significant, substantial correlations with established legacy instruments, including the Child PTSD Reaction Index (CPTSD-RI) and the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA), while discriminant validity is substantiated by moderate, lower-magnitude associations with generalized internalizing measures of childhood depression and anxiety. Confirmatory factor analyses have corroborated the tri-factor DSM-IV architecture while also supporting contemporary four-factor dysphoria and numbing structural variants. A total symptom score cutoff of 15 or greater reliably identifies children at heightened risk for clinical PTSD, providing clinicians and researchers with an efficient, empirically validated screening and treatment-monitoring tool.

Keywords

Child PTSD Symptom Scale, CPSS, Posttraumatic Stress Disorder, pediatric trauma assessment, DSM-IV PTSD criteria, trauma screening, re-experiencing, avoidance, hyperarousal, functional impairment, Edna B. Foa, psychometrics, child clinical psychology, youth trauma, trauma-focused cognitive behavioral therapy

Authors

The Child PTSD Symptom Scale (CPSS) was formulated by an expert group of clinical psychologists and trauma researchers led by Edna B. Foa, Ph.D., Professor of Clinical Psychology in Psychiatry at the Perelman School of Medicine, University of Pennsylvania, and Director of the Center for the Treatment and Study of Anxiety (CTSA). Dr. Foa is widely regarded as a pioneer in the conceptualization and evidence-based treatment of anxiety disorders and PTSD, having authored the foundational adult PTSD Symptom Scale (PSS) and formulated Prolonged Exposure (PE) therapy.

Co-investigators instrumental in the construction, developmental adaptation, and initial psychometric validation of the instrument include:

• Kathleen M. Johnson, M.S.S. — Center for the Treatment and Study of Anxiety, Department of Psychiatry, Medical College of Pennsylvania and Hahnemann University.
• Norah C. Feeny, Ph.D. — Currently Professor of Psychology and Director of the PTSD and Anxiety Research Program at Case Western Reserve University, whose empirical work focuses on adolescent trauma, randomized controlled trials, and cognitive behavioral interventions.
• Katherine R. H. Treadwell, Ph.D. — Clinical psychologist and researcher specializing in developmental psychopathology, cognitive mechanisms in pediatric anxiety, and child trauma assessment.

Purpose

The Child PTSD Symptom Scale was constructed to address a critical assessment gap in pediatric mental health: the need for a brief, theoretically sound, psychometrically robust, and developmentally appropriate measurement tool capable of evaluating both categorical diagnostic eligibility and dimensional symptom severity of posttraumatic stress disorder in youth. Prior to its release, many pediatric trauma batteries were either excessively lengthy structured diagnostic interviews requiring extensive clinical training and hours to administer, or adult scales modified ad hoc without formal developmental adaptation or psychometric validation. The CPSS resolved these limitations by translating the operational criteria of the DSM-IV into accessible, non-pejorative terminology that children as young as 8 years old can reliably comprehend and complete.

From a clinical perspective, the instrument serves multiple vital roles. First, it functions as an agile, low-burden screening mechanism in primary care, pediatric hospitals, community mental health clinics, and schools following localized or widespread traumatic events, such as school shootings, natural disasters, vehicular accidents, and community violence. Its rapid administration time (typically 10 to 15 minutes) allows practitioners to triage large cohorts of exposed children rapidly, pinpointing those in urgent need of comprehensive psychiatric evaluation. Second, because its items correspond directly to explicit cognitive, affective, and physiological symptoms, the CPSS serves as an indispensable treatment-monitoring instrument. Clinicians delivering interventions such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Prolonged Exposure for Adolescents (PE-A) administer the CPSS at baseline, mid-treatment, post-treatment, and follow-up intervals to quantify therapeutic progress, detect residual avoidance or hyperarousal symptoms, and evaluate whether gains generalize to real-world functional recovery.

In academic and epidemiological research, the CPSS offers a rigorous, standardized dimensional index of trauma severity that facilitates cross-study comparisons. It enables researchers to investigate the underlying etiopathology of pediatric trauma, identify neurobiological and environmental risk or resilience factors, model longitudinal developmental trajectories, and evaluate the empirical efficacy of novel pharmacological or psychosocial interventions in clinical trials. Furthermore, its dual-part construction—evaluating core clinical symptoms independently from daily life functional interference—aligns with modern diagnostic paradigms that mandate both symptom criteria and demonstrable clinical impairment before assigning a psychiatric diagnosis.

Psychological Construct

The CPSS operationalizes Pediatric Posttraumatic Stress Disorder as a multidimensional, trauma-induced psychological syndrome characterized by specific cognitive, behavioral, emotional, and neurobiological disruptions that emerge following exposure to one or more traumatic events involving actual or threatened death, serious injury, or violation of physical integrity. The scale measures the three foundational symptom clusters delineated by the DSM-IV alongside an explicit functional impairment dimension:

1. Re-experiencing / Intrusion (Criterion B)

This dimension encompasses the involuntary, unbidden re-emergence of the traumatic memory into present consciousness, indicating a failure of normative memory consolidation and contextual integration. In the CPSS, this construct is assessed through five developmentally tailored items that measure:

• Intrusive Thoughts and Images: Recurrent, distressing mental pictures or thoughts regarding the event that spontaneously enter the child’s mind outside voluntary control.
• Traumatic Nightmares: Frightening dreams whose content or emotional tone is directly linked to the traumatic event, frequently precipitating sleep disruptions.
• Dissociative Flashbacks: Subjective experiences wherein the child acts or feels as if the traumatic event is actively recurring in the present moment, sometimes accompanied by sensory illusions.
• Psychological Reactivity: Intense emotional distress (e.g., terror, guilt, despair) elicited by exposure to internal or external cues that symbolize or resemble an aspect of the trauma.
• Physiological Reactivity: Autonomic nervous system hyperactivation triggered by trauma reminders, manifesting as tachycardia, profuse diaphoresis, hyperventilation, somatic trembling, or gastrointestinal distress.

2. Avoidance and Emotional Numbing (Criterion C)

The second subscale assesses the maladaptive behavioral and cognitive strategies youth utilize to evade trauma-related distress, alongside the profound emotional constrictedness that frequently supervenes. Spanning seven items, this cluster captures:

• Cognitive and Affective Avoidance: Deliberate, effortful attempts to suppress thoughts, conversations, or feelings associated with the traumatic event.
• Behavioral Avoidance: Purposeful evasion of external triggers, including specific locations, individuals, activities, or situations reminiscent of the trauma.
• Psychogenic Amnesia: An inability to recall an essential, salient component of the traumatic experience, unrelated to organic brain injury or intoxication.
• Anhedonia: A marked diminution of interest or participation in previously enjoyed recreational, academic, or social pursuits.
• Interpersonal Detachment: Pervasive feelings of estrangement, alienation, or emotional disconnection from peers, caregivers, and family members.
• Restricted Affect: A blunted capacity to experience positive emotions (such as joy, warmth, or tenderness) or emotional expressions.
• Foreshortened Future: A pessimistic, constricted sense of the life course, characterized by an expectation that one will not reach adulthood, complete education, pursue a career, or enjoy normal longevity.

3. Hyperarousal (Criterion D)

This subscale gauges persistent, non-specific physiological hyperactivation reflective of a dysregulated, chronically sensitized hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system. Comprising five items, it measures:

• Sleep Disturbances: Difficulty initiating or maintaining restful sleep, characterized by prolonged sleep latency or frequent nighttime awakenings.
• Irritability and Affective Dysregulation: Unprovoked emotional outbursts, chronic irritability, or explosive anger out of proportion to situational stressors.
• Concentration Impairment: Marked difficulty sustaining cognitive focus, executive attention, or mental effort during academic tasks or reading.
• Hypervigilance: A chronic state of sustained, defensive alertness, characterized by relentless environmental scanning for potential threats.
• Exaggerated Startle Response: Heightened, involuntary motor and autonomic reactivity to unexpected, innocuous acoustic or tactile stimuli.

4. Functional Impairment (Criterion F)

In alignment with diagnostic thresholds, the CPSS incorporates a 7-item impairment module. This scale captures whether symptom manifestations cross the threshold into clinical significance by disrupting developmentally salient functional spheres: household responsibilities, social peer relationships, familial bonds, school academic achievement, recreational leisure/hobbies, religious/spiritual practices, and global subjective wellbeing.

Theoretical Framework

The Child PTSD Symptom Scale is theoretically grounded in Emotional Processing Theory (EPT), formulated by Edna B. Foa and Michael J. Kozak (1986), alongside cognitive-behavioral paradigms of trauma recovery. According to EPT, fear is mentally represented as an associative information network stored in long-term memory. This “fear structure” contains three interrelated categories of information: (a) stimulus information regarding the traumatic environment (e.g., sight of broken glass, scent of smoke, sound of screeching tires); (b) response information, including physiological reactions (e.g., racing pulse, muscle tension) and behavioral impulses (e.g., fleeing, freezing); and (c) interpretive meaning elements linking stimuli to threat and vulnerability (e.g., “I am completely helpless,” “The world is entirely dangerous”).

In youth who develop PTSD, this fear network becomes profoundly pathological. It is characterized by an excessively large number of associative nodes, unrealistic associations between innocuous stimuli and grave danger, and an erroneous belief that post-event physiological arousal signals impending catastrophe. Pathological fear structures resist natural extinction because the individual engages in pervasive cognitive and behavioral avoidance. By avoiding trauma reminders, the youth prevents the activation of the fear network, thereby precluding the incorporation of new, corrective, non-threatening information required for cognitive reorganization and emotional resolution.

The CPSS also integrates aspects of Developmental Psychopathology (Cicchetti & Toth, 1995) and the Cognitive Model of PTSD advanced by Ehlers and Clark (2000). Children possess immature cognitive processing capacities, meaning that traumatic stressors can disrupt foundational schema development regarding safety, trust, and predictability. When children lack sophisticated executive control to contextualize autobiographical trauma memories, those memories remain fragmented and poorly dated, triggering intrusive re-experiencing when exposed to matching perceptual cues. The CPSS operationalizes these theoretical tenets by capturing the cyclical interplay between intrusive re-experiencing (activation of the fear network), avoidance/emotional numbing (maladaptive strategies to avert network activation), and persistent hyperarousal (biological indices of threat processing).

Validity

The psychometric validity of the CPSS has been extensively established across clinical, non-clinical, and cross-cultural cohorts:

Construct and Structural Validity

In the seminal validation investigation conducted by Foa, Johnson, Feeny, and Treadwell (2001), the construct validity of the CPSS was tested in a sample of non-referred, school-based youth exposed to a major industrial earthquake disaster. The instrument demonstrated robust structural validity, with individual item-total correlations ranging from .36 to .71 across the symptom domain. The construct validity of the total score and subscales has been reinforced in clinical trials involving physically and sexually abused youth, survivors of motor vehicle accidents, and refugee populations.

Convergent Validity

Convergent validity has been evaluated against both structured clinical interviews and alternative self-report inventories. In the initial validation study (Foa et al., 2001), the CPSS total symptom score demonstrated a statistically significant, robust positive correlation with the Child PTSD Reaction Index (CPTSD-RI) (r = .80, p < .001). Subscale correlations with the CPTSD-RI were similarly elevated: Re-experiencing (r = .72), Avoidance (r = .65), and Hyperarousal (r = .68). Subsequent studies evaluating the CPSS against the gold-standard semi-structured interview, the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA), have consistently observed convergent correlations ranging between r = .70 and r = .83.

Discriminant Validity

Discriminant validity is supported by examining the CPSS’s relations with instruments assessing non-trauma-specific affective distress. Foa et al. (2001) administered the Children’s Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAIC) alongside the CPSS. While the CPSS total score correlated moderately with depression (r = .60 with CDI) and anxiety (r = .55 with STAIC-Trait), these coefficients were significantly lower than its correlation with the CPTSD-RI (r = .80), indicating that the CPSS measures a distinct posttraumatic construct rather than undifferentiated negative emotionality.

Criterion and Diagnostic Validity

Receiver Operating Characteristic (ROC) analyses have confirmed that the CPSS exhibits high diagnostic sensitivity and specificity for DSM-IV PTSD. Using structured diagnostic interviews as the criterion standard, a CPSS symptom cutoff score of 15 yielded an optimal balance of sensitivity (88%) and specificity (85%). In high-severity or clinical referral cohorts, a more conservative cutoff score of 20 has been recommended to maximize diagnostic specificity and positive predictive power.

Cross-Cultural Validity Considerations

Cross-cultural examinations highlight both universal structural stability and nuanced contextual divergences. In a rigorous cross-cultural adaptation study conducted in post-conflict Nepal by Kohrt et al. (2011), the CPSS was translated and validated among former child soldiers and war-affected youth. While the Re-experiencing and Hyperarousal subscales exhibited robust psychometric properties, the Avoidance subscale demonstrated attenuated measurement efficiency. In an active, conflict-affected post-war ecology, certain avoidance behaviors represented adaptive survival strategies rather than internalizing pathology, demonstrating the importance of contextual interpretation in global mental health assessment.

Reliability

The Child PTSD Symptom Scale has demonstrated exemplary reliability across diverse administrations and language translations:

Internal Consistency

In the original normative and psychometric investigation by Foa et al. (2001), the CPSS demonstrated high internal consistency across all domains:

• Total Symptom Scale (Items 1–17): Cronbach’s α = .89
• Re-experiencing Subscale (Items 1–5): Cronbach’s α = .80
• Avoidance / Numbing Subscale (Items 6–12): Cronbach’s α = .73
• Hyperarousal Subscale (Items 13–17): Cronbach’s α = .70

Subsequent investigations across clinical samples of traumatized youth have reported total symptom internal consistency estimates ranging from α = .88 to α = .93. Although the 7-item Functional Impairment scale uses dichotomous scoring (Kuder-Richardson 20 / ordinal alpha ranging from .70 to .78), its internal consistency is clinically satisfactory given the diverse life domains assessed.

Test-Retest Reliability

Temporal stability has been established in multiple longitudinal cohorts. In the initial psychometric study, test-retest reliability across a 1- to 2-week interval yielded an intraclass correlation coefficient (ICC) of r = .84 for the total symptom score. Subscale test-retest coefficients were similarly stable: Re-experiencing (r = .85), Avoidance (r = .72), and Hyperarousal (r = .76). Over longer test-retest periods (e.g., 4 to 6 weeks in untreated control cohorts), the scale retains stability (r > .75), demonstrating that the CPSS measures stable psychological constructs rather than transient daily mood swings.

Inter-Rater Reliability

When administered as a clinician-rated or semi-structured interview, the CPSS achieves high inter-rater concordance. Independent raters scoring child responses simultaneously have demonstrated inter-rater reliability coefficients exceeding r = .90 for total severity scores and Cohen’s kappa coefficients exceeding κ = .82 for diagnostic categorization.

Factor Analysis

The latent factor structure of the CPSS has been extensively examined using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to evaluate its alignment with psychiatric taxonomy.

Exploratory Factor Analyses

Early principal components and exploratory factor analyses conducted by Foa and colleagues identified three dominant factors with eigenvalues greater than 1.0, cleanly mapping onto the DSM-IV diagnostic architecture. Item factor loadings on their primary latent dimensions were robust (predominantly ranging between .45 and .78), with cross-loadings across secondary factors generally remaining below .30.

Confirmatory Factor Analyses

Subsequent psychometric investigations have subjected the 17 CPSS symptom items to rigorous CFA modeling, comparing multiple competing theoretical architectures:

• DSM-IV Tripartite Model: Comprising three correlated factors: Re-experiencing (5 items), Avoidance/Numbing (7 items), and Hyperarousal (5 items). While this model demonstrates acceptable fit across many pediatric samples (e.g., Comparative Fit Index [CFI] > .90, Root Mean Square Error of Approximation [RMSEA] < .06), it exhibits some conceptual tension regarding the unification of active behavioral avoidance and passive emotional numbing within a single latent construct.
• King et al. (1998) Four-Factor Model: Partitioning Criterion C into two distinct factors: Effortful Avoidance (Items 6–7) and Emotional Numbing (Items 8–12), alongside Re-experiencing (Items 1–5) and Hyperarousal (Items 13–17). CFA studies evaluating the CPSS have found that King’s four-factor emotional numbing model provides a statistically superior fit to the data compared to the traditional DSM-IV tripartite model (e.g., CFI = .94, Tucker-Lewis Index [TLI] = .93, RMSEA = .048).
• Simms et al. (2002) Dysphoria Model: Separating general dysphoric distress items across avoidance, numbing, and hyperarousal into an overarching “Dysphoria” factor. In several adolescent trauma samples, the dysphoria model also demonstrates excellent goodness-of-fit, capturing the substantial overlap between pediatric posttraumatic symptoms and generalized depressive-anxious distress.

Across these models, standardized factor loadings for individual items remain moderate to high (loadings > .50 for the vast majority of items), confirming that the 17 CPSS items serve as potent empirical indicators of their targeted latent dimensions.

Instrument / Measurement Tool

• Instrument Name: Child PTSD Symptom Scale (CPSS)
• Alternative Titles: CPSS-IV, Foa Child PTSD Scale
• Primary Author: Edna B. Foa, Ph.D.
• Publication Year: 2001
• Target Population: Children and adolescents aged 8 to 18 years
• Administration Modality: Youth self-report questionnaire or clinician-administered semi-structured interview
• Administration Time: Approximately 10 to 15 minutes
• Reading Level: 3rd to 4th grade reading level (accessible, child-friendly phrasing)
• Total Item Count: 26 items total:
  • Trauma Identification: Index trauma identification item (narrative write-in of most distressing event)
  • Part 1 — Symptom Severity: 17 items corresponding directly to DSM-IV PTSD diagnostic criteria
  • Part 2 — Functional Impairment: 7 items evaluating daily functional domains
• Subscale Architecture (Part 1):
  • Re-experiencing / Intrusion: Items 1 through 5 (Score range: 0 to 15)
  • Avoidance / Emotional Numbing: Items 6 through 12 (Score range: 0 to 21)
  • Hyperarousal: Items 13 through 17 (Score range: 0 to 15)
• Response Scales:
  • Part 1 (Items 1–17): 4-point Likert frequency scale based on the past 2 weeks:
    • 0: Not at all or only at one time
    • 1: Once a week or less / once in a while
    • 2: 2 to 4 times a week / half the time
    • 3: 5 or more times a week / almost always
  • Part 2 (Items 18–24): Dichotomous rating scale based on the past 2 weeks:
    • 0: No / Absent
    • 1: Yes / Present
• Scoring Formulas and Cutoff Benchmarks:
  • Total Symptom Severity Score: Calculated by summing the numerical ratings of Items 1 through 17. Total possible score ranges from 0 to 51. Higher scores indicate greater trauma-related distress.
  • Severity Classifications:
    • 0 – 10: Minimal or subclinical trauma symptoms
    • 11 – 15: Mild trauma symptoms
    • 16 – 27: Moderate posttraumatic symptomatology
    • 28 – 51: Severe posttraumatic symptomatology
  • Clinical Diagnostic Screening Cutoff: A total symptom score of 15 or greater serves as the recommended threshold indicating probable PTSD warranting comprehensive diagnostic assessment. (A cutoff of 20 or higher is utilized in clinical settings seeking to maximize diagnostic specificity).
  • DSM-IV Diagnostic Algorithm Mapping: A probable DSM-IV diagnosis can also be approximated categorically by requiring: (a) at least one Re-experiencing item rated ≥ 1; (b) at least three Avoidance/Numbing items rated ≥ 1; (c) at least two Hyperarousal items rated ≥ 1; and (d) at least one Functional Impairment item endorsed as “Yes” (1).
  • Total Functional Impairment Score: Calculated by summing items 18 through 24. Total possible score ranges from 0 to 7, reflecting the breadth of functional disruption.

Permissions & Fee and Test Year

The Child PTSD Symptom Scale (CPSS) was originally published in 2001 by Dr. Edna B. Foa and colleagues at the Center for the Treatment and Study of Anxiety, University of Pennsylvania. In its original DSM-IV formulation, the instrument was placed in the public domain for clinical practice, educational use, and non-commercial academic research. Clinicians and researchers are permitted to reproduce and administer the CPSS freely without royalty payments, provided proper formal bibliographic citation is maintained and the scale items are not altered.

Following the publication of the DSM-5 in 2013, Dr. Foa and colleagues developed an updated version: the Child PTSD Symptom Scale for DSM-5 (CPSS-5), available in both self-report (CPSS-5-SR) and clinician-administered interview (CPSS-5-I) formats. The CPSS-5 incorporates the fourth DSM-5 symptom cluster (negative alterations in cognitions and mood), expands the frequency scale to a 5-point Likert format (0 to 4), and uses a 1-month reporting window. While the classic CPSS remains freely accessible via public assessment repositories (such as the PerformWell clearinghouse and the National Center for PTSD), access to the newer CPSS-5 requires contacting the author and the Center for the Treatment and Study of Anxiety at the Perelman School of Medicine, University of Pennsylvania.

References

• Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child & Adolescent Psychiatry, 34(5), 541–565. https://doi.org/10.1097/00004583-199505000-00008
• Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/s0005-7967(99)00123-0
• Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35. https://doi.org/10.1037/0033-2909.99.1.20
• Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. H. (2001). The Child PTSD Symptom Scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376–384. https://doi.org/10.1207/S15374424JCCP3003_9
• Foa, E. B., Asnaani, A., Zang, Y., Capaldi, S., & Jerud, A. B. (2018). Psychometrics of the Child PTSD Symptom Scale for DSM-5 for trauma-exposed children and adolescents. Journal of Clinical Child & Adolescent Psychology, 47(1), 38–46. https://doi.org/10.1080/15374416.2017.1350962
• King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the DSM-IV posttraumatic stress disorder symptom clusters in civilian trauma survivors. Journal of Abnormal Psychology, 107(4), 669–674. https://doi.org/10.1037/0021-843X.107.4.669
• Kohrt, B. A., Jordans, M. J. D., Tol, W. A., Luitel, N. P., Maharjan, S. M., & Upadhaya, N. (2011). Validation of cross-cultural child mental health and psychosocial research instruments: Adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in Nepal. BMC Psychiatry, 11, Article 127. https://doi.org/10.1186/1471-244X-11-127
• Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress disorder symptoms in deployed and nondeployed Gulf War veterans. Journal of Abnormal Psychology, 111(4), 637–647. https://doi.org/10.1037/0021-843X.111.4.637

Items of the Scale