Development and Application of the Trauma Symptom Inventory™-2 (TSI™-2)
Trauma Symptom Inventory-2(TSI™-2)
The Trauma Symptom Inventory-2(TSI-2)isa revisedversion of the Trauma SymptomInventory (TSI™;Briere, 1995), a widely used test oftrauma-related symptomsand behaviors.Thismeasureevaluates acuteand chronic symptomatology, including, butnot limited to, the effectsof:Itevaluates symptomatologyassociated withtrauma at any point in the respondent’s lifespan; itdoes not link symptoms to a single stressor orspecific pointin time.
136 itemsAssessesawide rangeof potentially complexsymptomatology. (i.e., posttraumaticstress, dissociation,somatization, anddysfunctional behaviors.Normedandstandardized ona representative sample of the United Statesgeneral population.Itconsists of2 validityscales, 12clinical scales, 12 subscales, and4 factors
Trauma Symptom Inventory-2(TSI-2)
Goals for the Revision
To update existing items and skills to reflect new developments and research in the field of traumaTo respond to feedback from clinicians and researchers regarding strengths and limitations of the TSITo provide additional scales in order to measure symptom clusters not included in the TSITo address concerns regarding utility of the original ATR scale in detecting malingering of PTSD in forensic settingsTo modify the AA scale to include hyperarousalTo provide continuity between the TSI and theTSI-2
TSI to TSI-2
Added three (3) scales -Insecure Attachment(IA); Somatic Preoccupations (SOM);and Suicidality(SUI).Added two (2) subscales -AnxiousArousal–Hyperarousal (AA-H)and ImpairedSelf-Reference–Other-Directedness (ISR-OD).ThefourTSI™-2 factors (Self-Disturbance (SELF);PosttraumaticStress (TRAUMA);Externalization(EXT);andSomatization (SOMA)are either new to this version(EXT) and (SOMA) orreconfiguredbased on newly addedor modifiedscales(SELF)and(TRAUMA).The TSI™-2 validityscales contain new items, especially theAtypicalResponse (ATR) scale, which was redesigned to assessnot only over-reportingin general, but also to betterevaluate potentialmisrepresentation of posttraumatic stressdisorder (PTSD). In all, 87 items (i.e., 64%) are new totheTSI-2or have been rewritten to some degree.Added a Reliable Change ScoreNoracialdifferences werefound on the ATR scale in theTSI-2.For this reason, the TSI™-2does not require any adjustment ofATR scoresfor any specific racial or ethnic group.
Inthe general population, the lifetimeprevalence ofPTSD is approximately 8%.Prevalence rates in combatveterans, torturesurvivors, rape victims, refugees, and otherindividuals exposedto extremely stressful events canhave ratesas high as 30 to 60% (Breslau, Davis, Andreski,& Peterson, 1991; Kessler, Sonnega, Bromet,Hughes,& Nelson, 1995; Marshall, Schell, Elliott, Berthold, & Chun,2005; Ramchand et al., 2010; Steel et al., 2009).
Copyright © 2012 by David M. Schwartz, Ph.D. All rights reserved.
There is awide varietyof non-PTSD-specificsymptoms that are associatedwithchildhood and adult interpersonal victimization.These include:Mooddisturbances such as anxiety, depression,or anger(e.g., Gilboa-Schechtman & Foa, 2001;Heim &Nemeroff, 2001)Somatization(e.g., Dietrich, 2003; Walker, Katon,Roy-Byrne, Jemelka, & Russo, 1993)Identitydisturbance (e.g., Briere & Rickards, 2007; Cole& Putnam, 1992)Difficultiesin emotional regulation (e.g., vander Kolket al., 1996; Zlotnick, Donaldson, Spirito,& Pearlstein, 1997)Insecureattachment styles (e.g., Cloitre,Stovall-McClough, Zorbas, & Charuvastra, 2008; Harari, Bakermans-ranenburg, & Van IJzendoorn, 2007)Chronicinterpersonal difficulties (e.g., Elliott, 1994; Pietrzak, Goldstein, Malley, Johnson,& Southwick, 2009)Dissociation(e.g., Briere, Scott, & Weathers, 2005; Chu, Frey, Ganzel, & Matthews, 1999)Substanceabuse (e.g., Ouimette & Brown, 2003; Najavits, 2002)Suicidalthoughts and behaviors (Bebbington et al.,2009; Panagioti, Gooding, & Tarrier, 2009)Tensionreduction or externalization activitiessuch ascompulsive sexual behavior, bulimic eating, impulsiveaggression, and self-mutilation (e.g.,Briere& Gil, 1998; Zlotnick et al., 1997).These are not mutually exclusive!
Sometimes, symptomsarediverse and appearto arise from multiple adverse events, leading some clinicians referto complex posttraumatic outcomes,disorders ofextreme stress, or complexPTSD.Sometimes, symptoms include affect dysregulation, externalizing behaviors and relational disturbances. These may be organized as DSM-IV-TR Cluster B diagnoses.Given therange of potential outcomes, administrationof a measure that is limited to PTSDor someother single symptom or syndrome is unlikelyto besufficient to form an accurate or comprehensiveclinical viewof the trauma survivor (Courtois, 2004).Manypotential moderatorsand mediatorsof posttraumatic outcomes, includingdegree orfrequency of trauma exposure, preexisting affectregulation capacity, relational context, and comorbidpsychological symptomsor disordersmay make it difficult to concludethat Trauma X is associated with Outcome Ywithout alsotaking such factors into consideration.
Thealternate 126-item version of the form does not contain any sexual symptom items—the Sexual Disturbance scale (i.e., the Sexual Concerns and Dysfunctional Sexual Behavior subscales) and the sexual symptom items associated with the Externalization factor have been removed.Eightcritical items help you identify issues or behaviors that potentially represent severe psychological disturbance, danger to the respondent, or danger to others.Reliablechange scores are new to this edition of the measure and allow you to track progress and monitor change over time.Thevalidation sample consisted of fivenon-overlappingclinical groups: combat veterans, individuals with borderline personality disorder, sexual abuse victims, victims of domestic violence, and incarcerated women. A sample of subjects simulating PTSD was used to test malingering.
TheTSI-2was designed as a broad-spectrumassessment oftrauma-related symptoms and behaviors.It can beused to evaluate adults in a variety of clinicalsettings includinghospitals, inpatient and outpatient clinics,and schools.Itis appropriate for usewith multiplepresentingproblems including posttraumatic stress,insecureattachment, impairedself-reference, somatization, and “acting out” behaviors.TheTSI-2was standardized and validated on men andwomen inthe general population, ages 18 years and older.Separatenormative data are available for differentgendersandages.Flesch-Kincaidreadability analyses indicate that afifth-grade readinglevel is required to complete theTSI-2.