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Psychological
Assessment
1998,
Vol.
10,
No. 3,
215-220
Copyright
1998
by the
American Psychological Association,
Inc.
1040-3590/98/$3.00
Assessing
Acute
Stress Disorder:
Psychometric
Properties
of a
Structured Clinical Interview
Richard
A.
Bryant, Allison
G.
Harvey, Suzanne
T.
Dang,
and
Tanya Sackville
University
of New
South Wales
This
study
presents
the
development
of a
structured clinical interview
to
diagnose
acute stress
disorder
(ASD).
The
Acute
Stress
Disorder
Interview
(ASDI)
is a
19-item,
dichotomously
scored interview
schedule that
is
based
on
criteria
from
the
Diagnostic
and
Statistical Manual
of
Mental
Disorders
(4th
ed.;
American Psychiatric Association,
1994).
It was
validated against clinician-based diagnoses
of
ASD on 65
trauma survivors
assessed
between
1 and 3
weeks
posttrauma.
It
possessed
good
internal consistency
(r =
.90), sensitivity (91%),
and
specificity
(93%).
Test-retest
reliability was
evaluated
on 60
trauma survivors between
1 and 3
weeks
posttrauma,
with
a
readministration
interval
of
2 to 7
days.
Test-retest
reliability
of
ASDI severity
scores
was
strong
(r
=
.88),
and
diagnostic
agreement
for
presence (88%)
and
absence (94%)
of ASD
diagnosis
was
high.
The
ASDI appears
to be a
useful
tool
to
identify
those individuals
who
suffer
ASD and are at
risk
of
long-term
posttraumatic
stress disorder.
Acute
stress disorder
(ASD)
was
introduced
in the
Diagnos-
tic
and
Statistical
Manual
for
Mental
Disorders
(4th
ed.;
DSM-
IV;
American Psychiatric Association,
1994)
to
describe post-
traumatic
stress reactions that occur between
2
days
and 4
weeks
following
a
trauma.
The
major
difference
between
the
criteria
for
ASD and
posttraumatic stress disorder
(PTSD)
is the
former's
emphasis
on
dissociative symptoms.
Specifically,
to
satisfy
crite-
ria for a
diagnosis
of
ASD,
one
must
experience
a
stressor
and
respond
with
fear
or
helplessness (Criterion
A),
have
at
least
three
of five
dissociative symptoms (Criterion
B),
at
least
one
reexperiencing
symptom
(Criterion
C),
marked avoidance
(Cri-
terion
D), and
marked arousal (Criterion
E). A
major
rationale
for
the
introduction
of
this diagnosis
was to
identify
those
indi-
viduals
who are at risk of
developing longer term PTSD
(Koop-
man,
Classen,
&
Spiegel,
1994).
Despite
the
potential
utility
of
this
new
diagnosis
for
identifying individuals
at
risk
of
devel-
oping
chronic PTSD, there
are
currently
no
validated measures
of
ASD.
Researchers have traditionally indexed acute stress reactions
by
adopting measures that
have
been developed
for
PTSD.
For
example,
in
their studies, researchers have used
the
Impact
of
Event
Scale
(IBS;
Horowitz,
Wilner,
&
Alvarez,
1979)
to
index
acute
intrusions
and
avoidance (Bryant
&
Harvey, 1995, 1996;
Shalev,
1992)
or the
PTSD Symptom Scale
(Fba,
Riggs,
Richard
A.
Bryant, Allison
G.
Harvey, Suzanne
T.
Dang,
and
Tanya
Sackville, School
of
Psychology, University
of New
South Wales, Syd-
ney,
New
South
"Wales,
Australia.
Allison
G.
Harvey
is now at the
Depart-
ment
of
Psychiatry, University
of
Oxford, Oxford, England.
This research
was
supported
by
Grant
960654
from
the
National
Health
and
Medical Research Council.
Correspondence concerning this article should
be
addressed
to
Rich-
ard A.
Bryant, School
of
Psychology,
University
of New
South Wales,
Sydney,
New
South Wales
2052,
Australia. Electronic mail
may be
sent
to
r.bryant@unsw.edu.au.
The
Acute Stress Disorder Interview (ASDI)
is
available
at
http://www.psy.unsw.edu.au/~richardb/asdi/.
Dancu,
&
Rothbaum,
1993)
to
assess
the
range
of
intrusive,
avoidance,
and
arousal symptoms
in the
acute phase (Dancu,
Riggs,
Hearst-Dceda,
Shoyer,
&
Foa,
1996).
PTSD-related
mea-
sures
are
inadequate
in the
context
of
ASD,
however,
because
they
do not
encompass dissociative symptoms.
Numerous
stud-
ies
have used
the
Dissociative Experiences Scale
(DBS;
Bern-
stein
&
Putnam,
1986)
to
assess acute dissociative responses
(e.g.,
Bremner
et
al.,
1992; Dancu
et
al.,
1996). Similarly,
the
Peritraumatic
Dissociation Experiences Questionnaire
has
been
used
to
index dissociation that occurs during
a
trauma (Mannar
et
al.,
1994).
These scales
are
limited, however, because they
do
not
index intrusive, avoidance,
or
arousal symptoms,
and
they
have
not
been validated
as
measures
of
ASD.
Two
measures have recently been proposed
to
measure acute
stress responses.
The
Stanford
Acute
Stress Reaction Question-
naire (SASRQ;
Cardefla,
Classen,
&
Spiegel, 1991)
was
initially
developed
as a
73-item inventory that indexes stress symptoms
that
can
occur during
and
immediately
following
a
trauma.
The
SASRQ
has
been
subsequently
modified
as a
30-item inventory
that
indexes
ASD
symptoms
(see
Stain,
1996).
To
date, however,
there
is no
available data supporting
its
utility
in
identifying
individuals
who
satisfy
ASD
diagnosis.
The
Structured
Clinical
Interview
for
DSM-IV
Dissociative Disorders
(SCID-D;
Steinberg, 1993)
has
also been
offered
as a
structured interview
for
ASD. Although this interview encompasses
many
aspects
of
dissociative pathology, there
is
relatively little coverage
of the
other
ASD
symptoms,
and
there
are no
data concerning
the
utility
of the
SCID-D
in
identifying
ASD.
We
recognize that there
are
certain diagnostic problems that
are
somewhat
unique
to ASD
(see Bryant
&
Harvey, 1997).
Whereas most psychiatric diagnoses
are
moderately stable,
the
brief
and
reactive nature
of ASD may
predispose
it to a
fluctuat-
ing
course. This possible instability
may
result
in
variable diag-
nostic rates that depend,
in
part,
on
when
one is
assessed
in the
initial
month posttrauma. Potential problems also
arise
from
the
DSM-IV stipulation that
the
dissociative
symptoms
may
occur
215
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