The study aimed to validate the German version of the revised Trauma Symptom Inventory (TSI-2) by John Briere. TSI-2 assesses complex posttraumatic stress symptoms. In order to validate it, further instruments were applied, namely the Adverse Childhood Experience Scale, the CIDI list, the revised Impact of Event-Scale, the interview for complex posttraumatic stress disorder, the revised symptom checklist 90, the dissociative experiences scale, the inventory for interpersonal problems, and the self-efficacy questionnaire. The participants were N=100 traumatized psychiatric in-patients of a psychiatric hospital localized in the German-speaking part of Switzerland. The sample consisted of N=42 women. The study design was longitudinal with 2 assessments. The second assessment took place 4 weeks after the first, in order to investigate retest reliability. Here, N=17 patients participated, of whom N=8 were women. Regarding the results, on average, 3.5 aversive or traumatic experiences during childhood were reported, and 2,1 during adulthood. The diagnosis of (classical) PTSD was estimated at 33%. The results indicate that TSI-2 is both reliable and valid with respect to different criteria: Most scales and subscales of the TSI-2 showed acceptable to very good internal consistencies ( from 0.73 to 0.95) as well as good discriminatory power, and an acceptable retest reliability. Results also indicate good divergent and convergent construct validity as well as good criterion validity. It was not possible to replicate the 4-factor-model presented by the original author of the TSI-2. Instead, in line with the study that validated the German translation of the first version of the TSI-1, a 2-factor-model was found. There were gender differences regarding the TSI-2 scales with higher posttraumatic stress symptoms in women. In conclusion, there is evidence that indicates that the German translation of the TSI-2 is a reliable and valid instrument for the assessment of complex posttraumatic stress symptoms.
1. Wallis (2002) established sensitivity to change in an experimental study. After receiving group therapy, traumatized participants in the experimental group scored lower on 7 of the 10 clinical scales on the TSI and on the three composite scales. The researcher reported no similar reduction in symptoms in the control group.
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2. Resick, P.A., Nishith, P., & Griffin, M.G. (2003). How well does cognitivebehavioral therapy treat symptoms of complex PTSD?: An examination of child
sexual abuse survivors within a clinical trial. CNS Spectrums, 8, 340-342, 351-355.
4. Briere, J., Elliot, D.M., Harris, K., & Cotman, A. (1995). Trauma Symptom Inventory: Psychometrics and association with childhood and adult trauma in clinical samples. Journal of Interpersonal Violence, 10, 387-401.
9. Resick, P.A., Nishith, P., & Griffin, M.G. (2003). How well does cognitive-behavioral therapy treat symptoms of complex PTSD?: An examination of child sexual abuse survivors within a clinical trial. CNS Spectrums, 8, 340-342, 351-355.
A broadband measure, the TSI-2 is designed to evaluate posttraumatic stress and other psychological sequelae of traumatic events, including the effects of sexual and physical assault, intimate partner violence, combat, torture, motor vehicle accidents, mass casualty events, medical trauma, traumatic losses, and childhood abuse or neglect.
Recent immigration trends indicate that the United States is home to a remarkably diverse and rapidly growing population of displaced persons. Many of these individuals have survived exceptional trauma and are thus particularly vulnerable to trauma-related behavioral health disorders. Mental health professionals are commonly asked to assess immigrants within this population in the service of immigration court decision making. These assessments present a variety of challenges for clinicians, including the assessment and documentation of trauma-related symptoms across cultural bounds. The Trauma Symptom Inventory-2 (TSI-2) may be uniquely suited to the demands of immigration court assessments, but it has not been previously examined in a culturally diverse sample. The current study provided an examination of the TSI-2 within a sample of immigrants with histories of trauma. De-identified TSI-2 data were drawn from several clinicians' existing immigration assessment files. Reliability and standardization sample comparison results indicated that the TSI-2 exhibits sufficient internal consistency within this population, and that immigrants with histories of trauma generally respond similarly to individuals in trauma-specific clinical samples (with several notable exceptions). Specific clinical implications are discussed. (PsycINFO Database Record
Third, PTSD is often comorbid with other preexisting conditions or personality disorders, making it difficult to distinguish between feigned versus genuine PTSD symptoms and equally importantly, the cause of the credible ones (compensable injury or long-standing, unresolved trauma history unrelated to the event in question). The potential coexistence of legitimate preexisting PTSD and symptom exaggeration/re-attribution further complicates the differential diagnosis (Elhai et al., 2001; Hyer et al., 1987). All of these factors make assessing the credibility of PTSD symptoms quite a challenge. Therefore, having well-calibrated psychometric tools to distinguish between bona fide and non-credible PTSD is of paramount importance.
All the items are divided into 12 clinical scales, some of which are in turn divided into subscales. The 12 clinical scales are grouped into four factors: (1) self-disturbance (SELF), (2) posttraumatic stress (TRAUMA), (3) externalizing (EXT), and (4) somatization (SOMA) (see Table 1 for a more thorough representation of factors, scales, and subscales).
Finally, the TSI-2 provides two symptom validity scales: the response level (RL), which assesses the tendency to deny common problems or under-report symptoms that others readily acknowledge, and the atypical responses (ATR), which assesses the tendency to exaggerate trauma-related symptoms. The 8-item ATR scale contains symptoms rarely endorsed by individuals with genuine trauma history, and has been redesigned specifically for the TSI-2 to improve the identification of non-credible response sets. Specifically, the ATR scale was refashioned so to assess not only exaggeration of symptoms, but also an inaccurate representation of PTSD symptomatology. Its detection mechanism is based on the combination of indiscriminate endorsement of extreme levels of genuine symptoms (i.e., the method of threshold) as well as bizarre symptoms that are rarely endorsed by patients with bona fide PTSD (Briere, 2011). In other words, both over-endorsement of common symptoms and endorsement of rare symptoms could result in failing the ATR scale.
Consequently, high scores on the ATR scale may indicate high levels of genuine distress, but also random responding or non-credible presentation (i.e., malingered PTSD). Therefore, the clinical utility of the instrument may be compromised by the fact that the TSI-2 assesses not only extreme levels of PTSD symptoms, dysregulation, insecure attachment, and somatization, but also the exaggeration or outright fabrication of such symptoms. The fact that non-credible presentation and genuine elevation in symptoms can both inflate the score on the ATR scale poses significant conceptual and psychometric challenges in the standardization and clinical interpretation of the TSI-2 scores.
An apparent advantage of the TSI-2 is that it covers a wide range of potential sequelae of trauma history. The TSI-2 allows clinicians to generate a comprehensive symptom profile for patients who survived significant traumatic experiences. In addition, validity scales assess the tendency to exaggerate symptoms associate with trauma history. Moreover, the presence of some critical items and scales such as Suicidal Propensity, Sexual Disorders, or Behavior Aimed at Reducing Tension can alert the assessor to relevant clinical features that require immediate attention, especially with managing risk of suicide.
Overall, the TSI-2 would also benefit from more research on its classification accuracy across well-defined clinical populations with a wide range of demographic characteristics and geographic areas (Lichtenstein et al., 2019). The existing knowledge base on the ATR scale is limited by the reliance on simulation studies (Abeare et al., 2020; Carvalho et al., 2021; Hurtubise et al., 2020; Rai et al., 2019) and using performance validity testsFootnote 2 (as opposed to self-report symptom validity tests) as criterion measures (Gegner et al., 2021; Sabelli et al., 2021). Modality specificity is an increasingly recognized methodological artifact in calibrating instruments (Erdodi, 2021; Giromini et al., 2020; Lace et al., 2020; Schroeder et al., 2019). Therefore, cross-validating the ATR using strategically selected and well-established criterion measures is recommended before making high-stake decisions about the credibility of a given profile. Further empirical investigations are needed to determine the optimal cutoff on the ATR scales. Alternative validity scales based on different detection methods (response consistency, rarely endorsed symptoms, logistic regression equations) should also be considered. Finally, in an increasingly diverse world, studies examining the cross-cultural validity of the TSI-2 would greatly expand the scope of the instrument (Ali et al., 2020; Erdodi et al., 2017).
The Trauma Symptom Inventory (TSI; Briere, 1995) is a 100-item self-report measure of posttraumatic symptomatology that includes an Atypical Response (ATR) validity scale designed to differentiate honest from malingered profiles. In this study, using an analogue design to experimentally manipulate honest and malingered responses on the TSI, we found that proposed ATR cut scores produce a significant risk of false positives. Furthermore, the functioning of proposed cut scores worsened when we used posttraumatic stress disorder relevant samples and low estimates of malingering base rates. In light of these findings, the TSI should be used with caution when assessing claims of posttraumatic stress in forensic or disability settings. 589ccfa754
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