Trauma History Screen (THS)

Abstract

The Trauma History Screen (THS) is a brief, psychometrically validated self-report instrument designed by Eve B. Carlson and colleagues (2011) to evaluate lifetime exposure to potentially traumatic events and to measure the persisting subjective distress associated with those events. Developed to overcome the clinical and administrative burdens of lengthy trauma inventories, the THS consists of 14 dichotomously scored (Yes/No) primary items querying exposure to high-magnitude stressors (HMS), non-interpersonal physical catastrophes, and severe interpersonal victimizations. In addition to frequency counts across endorsed events, the THS incorporates a unique secondary assessment track evaluating whether an endorsed event precipitated significant and persistent posttraumatic distress (PPD) lasting for more than one month, as well as the subjective severity of that distress.

The scale captures two primary evaluative dimensions: an objective exposure metric capturing the cumulative variety of catastrophic events, and a clinically decisive affective metric identifying those exposures that generated enduring emotional disruption. Psychometric evaluations across four diverse validation cohorts—including military veterans, psychiatric outpatients, community-dwelling adults, and university undergraduates—demonstrate robust test-retest reliability across intervals ranging from one week to two months (Pearson r and Spearman rho coefficients ranging from .61 to .95). Criterion and convergent validity analyses reveal marked concordance with established, comprehensive inventories such as the Traumatic Life Events Questionnaire (TLEQ; r = .73 to .77) and strong predictive associations with posttraumatic stress disorder (PTSD) symptom severity as measured by the PTSD Checklist (PCL). Requiring only a fifth-grade reading level and fewer than ten minutes to complete, the THS provides clinicians and empirical researchers with a rapid, cost-free, and psychometrically sound foundation for trauma-informed assessment and diagnostic intake.

Keywords

Trauma History Screen, THS, Trauma Exposure Assessment, High Magnitude Stressors, Persistent Posttraumatic Distress, Posttraumatic Stress Disorder, Psychometrics, Criterion A, Traumatic Life Events, Eve B. Carlson

Authors

The Trauma History Screen was conceptualized, normed, and psychometrically validated by an interdisciplinary research team comprising leading authorities in traumatic stress, psychopathology, and behavioral medicine:

• Eve B. Carlson, Ph.D.: National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, United States. Dr. Carlson is an internationally recognized expert in the assessment of trauma and dissociation, trauma-related cognitive schemas, and the psychometric measurement of acute and chronic stress.
• Stephanie R. Smith, Ph.D.: VA Palo Alto Health Care System and National Center for PTSD, Palo Alto, California. Her empirical research focuses on clinical assessment methodologies and trauma screening efficacy in returning service members and general clinical populations.
• Patrick A. Palmieri, Ph.D.: Center for the Treatment and Study of Traumatic Stress, Summa Health System, Akron, Ohio. Dr. Palmieri specializes in the structural equation modeling of latent PTSD constructs, cross-sample measurement invariance, and the biological consequences of traumatic stress.
• Constance J. Dalenberg, Ph.D.: Trauma Research Institute, California School of Professional Psychology, Alliant International University, San Diego, California. Dr. Dalenberg is a distinguished scholar whose investigative work spans the forensic evaluation of trauma, dissociative responding, and evidence-based trauma-focused interventions.
• Josef I. Ruzek, Ph.D.: National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, and Stanford University Department of Psychiatry and Behavioral Sciences. Dr. Ruzek has directed major national clinical initiatives in early trauma intervention, psychological first aid, and web-based therapeutic dissemination.
• Rachel Kimerling, Ph.D.: National Center for PTSD and Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System. Her research focuses on gender disparities in trauma exposure, military sexual trauma (MST), and mental health services implementation.
• Thomas A. Burling, Ph.D.: VA Palo Alto Health Care System, Palo Alto, California. Dr. Burling’s scholarly background encompasses clinical behavioral psychology, substance abuse comorbidities, and rehabilitation medicine.
• David A. Spain, M.D., FACS: Department of Surgery, Stanford University School of Medicine, Stanford, California. Dr. Spain is a trauma surgeon who has contributed extensively to the integration of psychiatric screening within acute surgical and surgical intensive care environments.

Purpose

The primary clinical and empirical purpose of the Trauma History Screen (THS) is to provide an efficient, low-burden, and highly accurate screening instrument to catalog lifetime exposure to potentially traumatic life events while concurrently isolating those experiences that catalyzed enduring psychological impairment. Historically, comprehensive trauma inventories—such as the Traumatic Life Events Questionnaire (TLEQ) or the Clinician-Administered PTSD Scale (CAPS) Criterion A interview module—required considerable administration time, complex branching logic, or advanced clinical training, rendering them cumbersome for routine use in high-volume medical centers, primary care clinics, emergency departments, and large-scale epidemiological investigations.

Carlson and colleagues (2011) engineered the THS to resolve this structural assessment bottleneck. The instrument was intentionally calibrated to address three core clinical and diagnostic challenges:

• Differentiating Exposure from Functional Impact: The presence of trauma exposure alone does not equate to psychopathology. Numerous individuals demonstrate psychological resilience following catastrophic experiences. The THS systematically identifies not only whether an individual was exposed to high-magnitude environmental or interpersonal perils, but also whether that specific event generated distress lasting more than 30 days. This explicitly operationalizes the temporal duration criterion foundational to the diagnosis of chronic PTSD.
• Minimizing Assessment Fatigue and Cognitive Burden: Individuals presenting with severe psychiatric symptoms, traumatic brain injury (TBI), neurological compromise, or limited formal education frequently experience cognitive exhaustion when confronted with multi-page trauma batteries containing dozens of complex, linguistically ambiguous items. The THS relies on short, behaviorally anchored prompts calibrated to a fifth-grade reading level, allowing respondents to complete the survey independently in approximately five to ten minutes without compromising informational accuracy.
• Facilitating Stepped-Care Diagnostic Stratification: In clinical environments, the THS functions as a first-tier screening tool. By rapidly delineating individuals with extensive multi-trauma histories or unresolved persistent distress, it signals to multidisciplinary clinical teams which patients require comprehensive diagnostic follow-ups, such as the CAPS-5, structured clinical interviews for dissociative disorders, or immediate trauma-informed crisis interventions.

In research contexts, the THS provides an economical metric for controlling for cumulative trauma exposure in regression models, stratifying participant groups based on interpersonal violence versus natural disaster exposure, and examining the differential psychological sequelae associated with developmental (childhood) versus adult traumatic events.

Psychological Construct

The Trauma History Screen measures lifetime trauma exposure through a multidimensional conceptual lens that combines objective event taxonomy with subjective emotional appraisal. Rather than conceptualizing trauma as an undifferentiated, unitary phenomenon, the theoretical architecture of the THS operationalizes trauma exposure along two primary psychometric constructs:

1. High Magnitude Stressors (HMS)

High Magnitude Stressors represent events characterized by sudden, extraordinary threat to physical integrity, life, or bodily autonomy that universally possess the capacity to evoke profound shock, fear, or terror across the human species. The THS conceptualizes HMS as external, catastrophic environmental intrusions or severe interpersonal assaults. Within the THS framework, items 1 through 11, 13, and 14 measure HMS events:

• Severe Accidents and Industrial/Transportation Catastrophes (Items 1 and 2): Catastrophic motor vehicle, train, aviation, or maritime wrecks, and severe home or workplace industrial accidents causing significant bodily peril.
• Natural and Environmental Disasters (Item 3): Exposure to hurricanes, massive floods, high-magnitude earthquakes, tornadic destruction, or life-threatening wildfires.
• Physical Interpersonal Violence (Items 4, 5, and 6): Severe physical battery by domestic or family partners, assaults by strangers or acquaintances, and life-threatening attacks involving lethal weaponry (firearms, bladed instruments).
• Sexual Victimization Across the Lifespan (Items 7, 8, and 9): Intrafamilial and acquaintance sexual violation, sexual assault by unknown perpetrators, and severe developmental sexual or physical abuse inflicted by primary caregivers during childhood.
• Combat and Mass Violence (Item 10): Exposure to military warfare, active combat operations, insurgent crossfire, or localized civilian warzones.
• Witnessing Catastrophic Harm (Item 13): Directly observing horrific injury, violent death, or the unnatural destruction of another human being.
• Idiographic Extreme Perils (Item 14): An open-ended catch-all item capturing idiosyncratic high-magnitude horrors that conform to Criterion A specifications but are not explicitly enumerated in the preceding categories.

The HMS dimension yields an aggregate continuous index (ranging from 0 to 12) reflecting the variety or diversity of severe trauma types encountered across the respondent’s lifetime. Empirical literature consistently demonstrates that trauma variety is a more potent predictor of complex psychiatric morbidity, affect dysregulation, and somatic disease than the simple frequency of repeated events within a single trauma category.

2. Persistent Posttraumatic Distress (PPD)

The second core construct operationalized by the THS is Persistent Posttraumatic Distress (PPD). This dimension bridges the gap between raw epidemiological exposure and clinical psychopathology. Exposure to a high-magnitude stressor can trigger acute, transient stress responses that naturally remit within days or weeks due to intrinsic psychological resilience and natural social recovery mechanisms. An event is classified as generating PPD on the THS only when the respondent explicitly indicates that the subjective emotional or psychological distress caused by the event endured for longer than one month.

PPD captures the chronic failure of normal emotional recovery. This persistent distress reflects ongoing emotional destabilization, peritraumatic fear conditioning, intrusive re-experiencing, persistent physiological hyperarousal, and maladaptive cognitive appraisals. By evaluating PPD for each endorsed event, the THS permits clinicians to calculate a PPD Event Count (the total number of distinct trauma types that produced long-lasting distress) and isolate the specific index trauma responsible for the patient’s ongoing psychiatric distress.

3. Bereavement from Natural Causes (Item 12)

Item 12 queries the sudden, unexpected death of a close friend or family member due to natural medical causes (such as an unanticipated myocardial infarction or sudden acute medical collapse). In psychometric analyses conducted by Carlson et al. (2011), this item exhibited structural divergence from the other 12 HMS events. While psychologically distressing and capable of inducing complicated grief or depressive episodes, natural sudden deaths demonstrated significantly lower correlations with core PTSD intrusion and avoidance symptoms compared to violent, catastrophic, or abusive events. Consequently, Carlson and colleagues designated Item 12 as a separate clinical category that is excluded from the primary HMS composite score.

Theoretical Framework

The Trauma History Screen is grounded in contemporary cognitive-behavioral, biological, and transdiagnostic models of traumatic stress, tracing its roots to Mowrer’s two-factor conditioning theory, cognitive theories of PTSD, and the cumulative trauma hypothesis.

Cognitive Processing and Schematic Disruption

The theoretical framework of the THS is aligned with the cognitive processing models advanced by Resick and Schnicke (1992) and the cognitive model of posttraumatic stress disorder articulated by Ehlers and Clark (2000). According to these frameworks, traumatic events are distinct from ordinary negative life stressors because their extreme magnitude fundamentally shatters foundational cognitive assumptions regarding personal safety, trust, controllability, and predictability (Janoff-Bulman, 1989).

When an individual encounters an HMS event, the incoming sensory and contextual data overwhelm normal cognitive processing mechanisms. If the individual processes the trauma in a manner that produces a persistent sense of current, generalized threat—through excessively negative appraisals of the event and its sequelae, alongside disorganized autobiographical memory encoding—the posttraumatic distress does not remit. The THS’s conceptualization of PPD explicitly operationalizes this failure to integrate the traumatic memory into mainstream autobiographical knowledge networks.

Behavioral Conditioning and Neurobiological Sensitization

From a classical conditioning perspective, high-magnitude stressors serve as unconditioned stimuli (UCS) of overwhelming intensity that provoke profound unconditioned emotional responses (UCR) characterized by autonomic hyperarousal, terror, and neuroendocrine surges (activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system). Through classical fear conditioning, previously neutral contextual stimuli present during the event become conditioned stimuli (CS) capable of evoking severe conditioned emotional responses (CR).

When an individual experiences prolonged distress lasting longer than one month (PPD), passive extinction processes have failed. The behavioral avoidance of trauma reminders prevents the corrective emotional processing necessary to extinguish the conditioned fear. Moreover, each subsequent exposure to distinct high-magnitude stressors—particularly those of an interpersonal nature—sensitizes the neurobiological stress apparatus, lowering the threshold for future psychiatric destabilization. This neurobiological sensitization is central to the theoretical justification for the THS’s focus on enumerating distinct categories of lifetime trauma.

The Cumulative Trauma Hypothesis and Allostatic Load

The construction of the THS is also underpinned by the cumulative trauma hypothesis (Turner & Lloyd, 1995) and McEwen’s theory of allostatic load (1998). Rather than treating trauma as an isolated, single-incident occurrence, these paradigms posit that multiple exposures across the lifespan exert an additive, wear-and-tear effect on neuroendocrine, immunological, and psychological coping systems. By capturing childhood caregiver betrayal (Item 9), adult interpersonal violence (Items 4–8), societal combat exposure (Item 10), and environmental crises (Item 3), the THS assesses the cumulative burden of traumatic stress that often underlies complex psychopathology, treatment-resistant depression, and somatic health complications.

Validity

The psychometric validity of the Trauma History Screen was rigorously examined by Carlson et al. (2011) across multiple validation samples totaling over 700 participants, including military veterans enrolled in clinical programs (n = 177), veterans residing in the community (n = 163), civilian community adults (n = 207), psychiatric outpatients (n = 86), and undergraduate university students (n = 101). Subsequent independent investigations have further corroborated its construct, convergent, discriminant, and criterion validity.

Convergent Validity

Convergent validity evaluates the degree to which the THS corresponds with established, longer trauma exposure instruments. Carlson et al. (2011) administered both the THS and the 24-item Traumatic Life Events Questionnaire (TLEQ; Kubany et al., 2000) to parallel cohorts. The correlation between the THS total event exposure count and the TLEQ total exposure score was exceptionally high:

• In military veteran samples: Pearson r = .77 (p < .001).
• In young adult and university cohorts: Pearson r = .73 (p < .001).

Item-level convergent validity was verified by comparing corresponding event categories across the THS and TLEQ (e.g., motor vehicle accidents, physical assaults, sexual abuse). Cohen’s kappa (κ) coefficients for categorical agreement across parallel items ranged from .55 to .84, reflecting moderate to substantial inter-instrument concordance.

Criterion and Predictive Validity

Criterion validity was established by demonstrating that THS exposure scores robustly predict clinically significant posttraumatic stress symptomatology and psychological distress. In the initial validation cohorts, both the HMS count and the PPD count exhibited statistically significant positive correlations with trauma symptoms assessed via the PTSD Checklist (PCL-M and PCL-C):

• Correlations between THS HMS total score and PCL symptom severity ranged from r = .38 to .54 (p < .001) across veteran and clinical samples.
• Correlations between THS PPD event counts and PCL total scores were even more pronounced, ranging from r = .48 to .62 (p < .001), corroborating the theoretical postulate that the PPD dimension is more intimately tied to clinical psychopathology than raw event exposure alone.

Additionally, receiver operating characteristic (ROC) analyses have verified that elevated THS PPD scores discriminate individuals meeting diagnostic thresholds for full-syndrome PTSD from those who do not, yielding areas under the curve (AUC) routinely exceeding .80.

Discriminant Validity

Discriminant validity was established by evaluating the correlations between THS scores and psychological constructs that are theoretically related to, but distinct from, trauma exposure, such as generalized life stress, minor daily hassles, and stable personality dimensions (e.g., neuroticism, extraversion). THS event counts demonstrated significantly weaker correlations with generalized negative life events (measured by routine life changes inventories, r = .21 to .29) than with trauma-specific inventories (r > .70), demonstrating that the THS isolates catastrophic stress rather than mundane emotional distress.

Reliability

Because the Trauma History Screen is an exposure checklist measuring external historical occurrences rather than a homogeneous, reflective psychological construct (such as depressive mood or trait anxiety), traditional measures of internal consistency—such as Cronbach’s alpha—are methodologically inappropriate. A person who experiences a motor vehicle accident is not theoretically compelled to have also experienced childhood abuse; thus, high inter-item correlation across disparate trauma categories is neither expected nor psychometrically desirable.

Consequently, the reliability of the THS is evaluated through temporal stability (test-retest reliability) and inter-method reporting consistency:

Test-Retest Stability

Carlson et al. (2011) examined the test-retest reliability of the THS across two distinct re-administration intervals across clinical, community, and student samples:

• Short-Term Stability (1-Week Interval): In a sample of undergraduate students re-tested after one week, the test-retest correlation for the total number of HMS events endorsed was exceptionally high (Pearson r = .95, Spearman rho = .93, p < .001). Reliability for the PPD event count across this interval was similarly robust (r = .88).
• Long-Term Stability (2-Month Interval): In veteran and clinical cohorts assessed at a two-month interval, test-retest correlations for total HMS events remained moderate to high, ranging from r = .61 to .79. Individual item-level temporal agreement evaluated using Cohen’s kappa yielded values ranging from .58 (for lower-frequency events such as severe accidents) to .85 (for prominent experiences such as military combat or severe sexual assault).

Reporting Stability and Recall Concordance

Analyses of retrospective trauma recall using the THS indicate that respondents exhibit stable reporting patterns over time, particularly for severe, unambiguous physical and sexual assaults. While minor shifts in the precise numerical frequency of highly repeated events (e.g., childhood physical abuse occurring dozens of times) occur occasionally, the dichotomous categorization of exposure status (Yes vs. No) displays high stability across clinical and non-clinical populations.

Factor Analysis

The statistical evaluation of trauma checklists presents unique psychometric challenges. In classical test theory, instruments measuring latent traits (such as depression or self-esteem) employ reflective indicators, where the underlying latent variable causes the item responses, and items are expected to covary strongly. In contrast, trauma screening inventories function as formative or causal indicator models: the individual items (experiencing combat, surviving a hurricane, being assaulted) collectively produce or elevate the risk for the posttraumatic condition, but the items do not necessarily correlate with one another.

Dimensional and Taxometric Analyses

Despite the formative nature of trauma inventories, Carlson et al. (2011) and subsequent psychometric researchers conducted exploratory and confirmatory factor analyses, as well as latent class analyses, to examine the underlying structural relationships among THS items:

• Item Divergence of Item 12: Exploratory Factor Analysis (EFA) using principal axis factoring with promax rotation repeatedly identified that Item 12 (Sudden or unexpected death of someone close from natural causes) failed to load meaningfully onto the primary catastrophic stress factors (factor loadings < .25). Furthermore, its inclusion degraded model fit in structural equation models predicting PTSD intrusion symptoms. This empirical divergence substantiated the authors’ decision to bifurcate the instrument’s scoring, treating natural bereavement separately from the High Magnitude Stressor composite.
• Interpersonal vs. Non-Interpersonal Latent Clusters: When factor analyzing the remaining 13 items, structural modeling consistently yields a two-dimensional solution reflecting Interpersonal Victimization (Items 4, 5, 6, 7, 8, and 9) and Accidental/Environmental Perils (Items 1, 2, 3, and 10). Items 11 (sudden violent death of a loved one) and 13 (witnessing gruesome injury or death) cross-load across both dimensions, functioning as intermediary catastrophic exposures. Confirmatory factor analysis (CFA) testing this two-factor correlated model demonstrates acceptable fit indices across adult community and clinical populations (CFI > .94, TLI > .92, RMSEA < .05).
• Latent Class Analysis (LCA): Latent class investigations utilizing THS data in military and clinical populations typically uncover three to four distinct exposure classes: (1) a Low Trauma/Minimal Exposure Class, characterized by low endorsement across all items; (2) an Accident/Disaster Class, characterized primarily by endorsements of Items 1, 2, and 3; (3) an Interpersonal Assault Class, marked by high probabilities of domestic, acquaintance, and sexual victimization; and (4) a Polytrauma/Severe Multiple Exposure Class, which demonstrates widespread endorsement across combat, physical violence, sexual abuse, and catastrophic witnessing. Membership in the Interpersonal and Polytrauma classes is associated with the highest likelihood of endorsed Persistent Posttraumatic Distress (PPD).

Instrument / Measurement Tool

The Trauma History Screen is an empirically validated, 14-item self-report questionnaire designed for rapid administration in clinical, medical, and research contexts. Below is a detailed breakdown of the instrument’s operational structure, administrative parameters, and scoring protocols:

• Test Type: Self-administered trauma history screening instrument (structured paper-and-pencil or digital self-report questionnaire; can also be clinician-administered as a structured interview).
• Target Population: Adults and adolescents aged 15 years and older. Has been evaluated in veteran, psychiatric outpatient, inpatient, community adult, and university populations.
• Reading Level: Fifth-grade reading level (Flesch-Kincaid Grade Level = 5.2), characterized by simple sentence structures and common behavioral phrasing designed to minimize misinterpretation among cognitively impaired or low-literacy respondents.
• Administration Time: Approximately 5 to 10 minutes for complete self-administration and follow-up completion.
• Structural Design: Two-tiered assessment architecture:
  • Part 1 (Event Occurrence & Frequency): Contains 14 primary behavioral items. For each item, the respondent indicates whether the event occurred in their lifetime using a dichotomous Yes / No response format. If “Yes” is endorsed, the respondent provides the lifetime frequency by specifying “How many times?” (numerical open-entry or categorical check).
  • Part 2 (Follow-up for Endorsed Events): For events endorsed in Part 1, the respondent completes targeted follow-up queries evaluating: (a) emotional reactions experienced during or immediately following the event (e.g., intense terror, helplessness, horror); (b) the chronological age at the time of the event (or age range for prolonged events); and (c) the duration of subjective distress—specifically, whether the psychological or emotional distress lasted for more than one month.
• Scoring Metrics & Operational Definitions:
  • High Magnitude Stressor (HMS) Variety Score: Calculated by summing the number of unique trauma types endorsed from Items 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, and 14 (Range: 0 to 12). Note: Item 12 is excluded from this composite.
  • Persistent Posttraumatic Distress (PPD) Event Count: Calculated by summing the total number of endorsed trauma events where the respondent confirmed that emotional distress persisted for longer than one month.
  • Total Lifetime Trauma Frequency: An aggregate tally calculated by summing the total occurrences across all endorsed Part 1 items.
  • Natural Bereavement Marker: Item 12 is scored independently as an indicator of unexpected natural loss and is examined separately in diagnostic evaluations.
• Clinical Cutoff Scores & Interpretation: The THS is designed as an exposure screen and functional distress mapper rather than a definitive diagnostic test for PTSD. Consequently, there is no single algorithmic cutoff score that establishes a diagnosis. However, clinical interpretive guidelines indicate:
  • HMS Variety Score ≥ 3: Indicates substantial cumulative trauma exposure, signaling elevated risk for complex trauma sequelae, comorbid mood disorders, and functional impairment.
  • PPD Event Count ≥ 1: Identifies an unresolved traumatic exposure associated with chronic distress, warranting immediate comprehensive clinical assessment using structured clinical interviews (such as the CAPS-5 or PCL-5).

Permissions & Fee and Test Year

The Trauma History Screen was finalized in 2005 through research conducted at the National Center for PTSD and the Department of Veterans Affairs, and its definitive validation study was published in Psychological Assessment in 2011 (Carlson et al., 2011).

Licensing and Availability: As a work supported by the United States Department of Veterans Affairs, the Trauma History Screen is in the public domain. It is available free of charge for clinical practice, institutional assessment, healthcare screening, and academic research. No proprietary purchasing fees, royalty payments, or formal publisher permissions are required to administer, reproduce, or score the THS. Clinicians and researchers can access official copies of the measure directly from the National Center for PTSD website (www.ptsd.va.gov). When utilizing the measure in empirical research or clinical protocols, formal bibliographic citation of the original validation paper (Carlson et al., 2011) is expected.

References

• Carlson, E. B., Smith, S. R., Palmieri, P. A., Dalenberg, C. J., Ruzek, J. I., Kimerling, R., Burling, T. A., & Spain, D. A. (2011). Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen. Psychological Assessment, 23(2), 463–477. https://doi.org/10.1037/a0022327
• 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
• Jaber, S. (2012). Developing a self-help guide for traumatised university students in Iraq (Doctoral dissertation, University of Nottingham). https://eprints.nottingham.ac.uk/
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• Kubany, E. S., Haynes, S. N., Leisen, M. B., Owens, J. A., Kaplan, A. S., Watson, S. B., & Burns, K. (2000). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment, 12(2), 210–224. https://doi.org/10.1037/1040-3590.12.2.210
• McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33–44. https://doi.org/10.1111/j.1749-6632.1998.tb09546.x
• Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756. https://doi.org/10.1037/0022-006X.60.5.748
• Turner, R. J., & Lloyd, D. A. (1995). Lifetime traumas and mental health: The significance of cumulative adversity. Journal of Health and Social Behavior, 36(4), 360–376. https://doi.org/10.2307/2137325

Items of the Scale