Assessing for trauma

“Assess for trauma” (NBCC, 2027 task 2B.1)

Many clients have experienced trauma, often without naming it as such. Counselors screen for trauma history and trauma-related symptoms in a way that is safe and does not retraumatize. The exam tests DSM-5-TR trauma criteria, symptoms of trauma, and trauma-informed assessment.

Key points

DSM-5-TR PTSD requires exposure to actual or threatened death, serious injury or sexual violence (directly, as a witness, by learning it happened to someone close, or by repeated exposure to aversive details through work), plus symptoms of intrusion, avoidance, negative changes in thought and mood, and changes in arousal and reactivity, lasting more than one month.
Acute stress disorder covers similar symptoms from 3 days to 1 month after the event.
Trauma can also present as depression, substance use, dissociation, somatic complaints, sleep problems or relationship difficulties.
Trauma-informed assessment emphasizes safety, choice, collaboration, trustworthiness and empowerment; the client controls how much detail to share.
Screening tools such as the PCL-5 (a 20-item self-report of DSM-5 PTSD symptoms) or brief primary care screens can support the interview.
Children may show trauma through play, regression, behavior changes or somatic complaints; DSM-5-TR has separate PTSD criteria for children 6 years and younger.
Cultural context shapes how trauma is experienced and described; consider historical, community and racial trauma.

In practice

During intake, a counselor asks a client whether she has experienced anything very frightening or upsetting, and adds that she does not need to give details today. The client mentions a car accident; the counselor asks about current nightmares, avoidance and startle responses instead of the event itself.

A 7-year-old's teacher reports new bedwetting and refusal to play outside. With parental consent, the counselor gathers history and learns of a recent house fire, then assesses for trauma symptoms through play and parent report.

Check yourself

How long must PTSD symptoms last for a DSM-5-TR diagnosis?

More than one month; from 3 days to 1 month after the event, acute stress disorder may apply.

Why avoid asking a client for detailed trauma narratives at intake?

Detailed recounting before safety and rapport are established can retraumatize, and the client should control what they share.

Give two ways trauma may present in children.

Regression such as bedwetting and repetitive trauma themes in play, among other behavior changes and somatic complaints.

NBCC's knowledge and skills for 2B. Assessment

Knowledge of: Foundational knowledge of statistics; Diagnostic criteria - DSM-5-TR; Diagnostic Criteria - ICD-11; Symptoms of trauma; Medical diagnoses and symptoms that can contribute to mental health symptoms; Differential diagnoses, co-occurring diagnoses, and comorbidities; Risk assessment and risk factors or symptoms; Cultural idioms of distress; Cultural implications of diagnosis.

Skill in: Conducting a diagnostic assessment and evaluation; Conducting and interpreting assessments; Conducting formal assessments; Conducting informal assessments; Conducting lethal means restriction.

A study guide written by ExamDragon from NBCC's published task; not NBCC material and not part of the exam.