Ralph L. Piedmont, Ph.D.
Loyola College in Maryland
I. General Information
Title: Trauma Symptom Inventory (TSI).
Authors: John Briere
Publishers: Psychological Assessment Resources,
Inc. P.O. Box 998, Odessa, FL 33556 Phone: 1-800-331-8378.
Forms; groups to which applicable: The
TSI has been standardized on a general population of men and women,
ages 18 and above. It includes separate norms for men and women as
well as by various age groups. Items are written at the fifth to seventh
grade level. There is also an abbreviated version of the instrument
which omits items relating to sexual concerns, making it more appropriate
for adolescents and young adults.
General Type: The TSI is intended for use in
clinical settings to evaluate the presence of acute and chronic traumatic
symptomatology. The ten clinical scales capture a wide range of affective,
cognitive, and physical problems and/or issues.
Date of Publication: The TSI was published in
Practical Features: The TSI is a self-administered,
paper and pencil inventory that is readily completed by clients. The
item booklet is reusable and the response form is amenable to ready
scoring and interpretation. Also available is a home computer scoring
program with unlimited scoring. This program will profile not only
13 scales but provide three additional summary factor scales (Self-Factor,
Trauma Factor, and Dysphoria Factor).
Cost: Reusable item booklets cost $24.00 for
packages of 10 and hand scorable answer sheets cost $35.00 for packages
of 25. Packages of 100 answer sheets can be purchased for $129.00.
Male and female profile sheets are sold separately and cost $25.00
for packages of 25. The home computer scoring program costs $199.00.
Time required to administer: It takes approximately
20 minutes to complete the TSI.
II. Purpose and Nature of the Instrument
Stated Purpose: The TSI was developed to provide
a comprehensive measurement instrument for assessing psychological
trauma as a result of rape, spouse abuse, physical assault, combat,
major accidents, and natural disasters. It also aims to capture the
lasting impact of childhood abuse and other early traumatic events.
The TSI is intended to capture a broad array of trauma-related symptom
issues, spanning the intrapersonal, interpersonal, and physical functioning
domains. The 10 clinical scales are fully normed by gender and age
group. The TSI also includes three validity scales designed to detect
efforts at dissimulation.
Description of test, items, and scores: The
TSI is a 100 item questionnaire where respondents indicate the frequency
with which they engaged in various behaviors over the past 6 months
on a (0) never to (3) often Likert-type scale. These items constitute
10 clinical scales: Anxious Arousal, Depression, Anger/Irritability,
Intrusive Experiences, Defensive Avoidance, Dissociation, Sexual Concerns,
Dysfunctional Sexual Behavior, Impaired Self-Reference, and Tension
Reduction Behavior. There are also 3 "validity" scales aimed
at identifying various efforts at either denying symptoms (the Response
Level scale), at over endorsing dysfunctionality (the Atypical Response
scale), or randomly responding (the Inconsistent Response scale).
Raw scores on these scales are converted to age and gender specific
T-scores. Scores greater or equal to a T-score of 65 warrant interpretation.
Use in Counseling: The value of the TSI
in counseling is that it can provide therapists with a normed index
of symptomological distress in clients resulting from a traumatic
experience. The scale is sensitive to not only recent traumatic events
but also captures the residual, chronic effects of childhood trauma.
The diversity of content scales offers an array of clinically useful
insights into clientsĖ functioning.
III. Practical Evaluation
Usefulness of manual: The 61 page manual is
filled with detailed information on the scoring and interpretation
of the instrument. Four case studies are presented for detailed interpretation
and help facilitate the userĖs sense of competence. The manual provides
detailed information on the reliability and validity of the instrument.
This is important given the lack of much published research on the
TSI. Overall, the manual is clear, readable, and very informative.
Adequacy of directions for administering the
instrument: As noted above, the TSI manual is very clear and helpful
in explaining how to administer, score, and interpret the instrument.
Given that the TSI can be self-administered, there are few directions
needed. What is important is how to hand score the instrument, which
can be complicated, especially for a novice. However, the manual does
take one through the procedure step-by-step.
Qualifications of examiners: The TSI should
be used by counselors who have an advanced degree from an accredited
institution as well as having satisfactorily completed a course in
psychological testing and statistics. Given the clinical nature of
the instrument, it would be helpful if the user also had educational/practical
experience with personality theory and psychopathology.
Scoring Provisions: The TSI is hand scorable,
which can be accomplished in 15-25 minutes. A home computer scoring
program is also available which produces a multi-page client report.
IV. Technical Considerations
Normative sample: The normative group consists
of a national, stratified, random sample of 836 individuals who closely
approximate demographics obtained in the 1990 Census, although one
should not consider this norm group to be demographically representative.
Analyses did reveal significant differences in scores due to both
gender and age. As a result, separate normative information for these
groups were created. However, there are some slight differences in
scores due to race, with African-Americans and Hispanics scoring significantly
higher than the other racial groups on all three validity scales and
three of the clinical scales. The author claims that the relatively
small effect size for these differences mitigated against any separate
racial norms. These differences need to be considered when interpreting
the TSI for these racial groups. There is also normative information
presented for a sample of over 3,500 male and female Navy recruits.
Reliability: In the normative sample, alpha
reliabilities for the ten clinical scales range from .74 (Tension
Reduction Behavior) to .91 (Depression), mean alpha is .86. Comparable
values are found in three other samples, a university group, a clinical
sample, and the Navy recruits. No test-retest information is presented
for the scales.
Validity: The manual provides data on a series
of studies examining various validity aspects of the TSI. Overall,
the scales of the TSI represent 3 highly inter-correlated broad factors:
Self, Trauma, and Dysphoria. Information presented in the manual shows
that the TSI scales were significantly higher for those who had experienced
various types of trauma. Scores on several of the clinical TSI scales
were shown to correlate substantially with other measures of posttraumatic
stress. The evidence presented in the manual is supportive of the
TSI as being a useful indicator of traumatic symptoms and can be useful
in identifying those who may have experienced trauma. An interesting
set of analyses presented in the manual concern an evaluation of the
incremental validity of the TSI: Does it provide additional information
about trauma experience over and above what other currently available
tests can provide? The results of these data were mixed. In predicting
victimization history, the TSI provided significantly more explanatory
variance over the Impact of Event Scale, Symptom Check List and Brief
Symptom Inventory. However, this incremental validity was only evidenced
for women. Thus, there is some evidence that the TSI captures unique
aspects of trauma not available in other measures of symptom experience.
Runtz and Roche (1999) evaluated the validity of the TSI in a Canadian
sample of university women and found that the scales were able to
discriminate significantly between those physically and sexually abused
and those not abused. The TSI also correlated with other measures
of stress, behavior, and health. Briere, Elliott, Harris, and Cotman
(1995) provided psychometric data on the TSI in a sample of 370 psychiatric
inpatients and psychotherapy outpatients. Again, those individuals
reporting incidents of abuse and trauma scored significantly higher
on all ten clinical scales than those not making such reports. Also
noted was that various client demographic variables (e.g., sex, age,
inpatient versus outpatient status) were significantly related to
Comments of reviewers: Due to the TSIĖs relatively
recent publication, there are no available reviews.
General Evaluation: The Trauma Symptom Inventory
aims to evaluate a broad array of clinically salient dimensions relevant
to posttraumatic stress experiences. Unlike other available instruments,
the TSI examines issues around self functioning (e.g., sexual issues,
tension experience), emotional dysphoria (e.g., depression, anxiety),
and trauma impact (e.g., defensive avoidance, dissociation). Correlations
with other measures of posttraumatic stress show the TSI to capture
a broader personological spectrum. The internal consistency of the
scales are quite adequate, although there are no extant data on the
long term stability of the scales. This is especially important given
the scaleĖs aim to capture the long term, characterological effects
of early trauma. Data do show that the TSI renders higher scores in
traumatized samples than in non-traumatized samples; it still needs
to be determined whether scores on the TSI decrease over the course
of treatment. Showing such an effect would support the TSI as a useful
outcome index for therapy dealing with traumatized individuals, and
would seem an obvious next step for research using this tool. The
authorĖs attempt at demonstrating incremental validity for the TSI
is to be applauded. Incremental validity studies provide more rigorous
evaluations of a testĖs utility. The results of this analysis indicated
that the TSI may be more useful for women than men. Clearly, the role
of gender on response patterns needs to be examined further. Perhaps
the items are more sensitive to the experiences and concerns of women
One issue that needs to be addressed is
the inclusion of "validity scales". The author clearly sees
this as a "plus" for the instrument; individuals in clinical
contexts may exaggerate or minimize their problems. Some may even
dismiss the task of test completion entirely. Measures of response
validity are very common in clinical instruments, but there is a growing
body of evidence that such scales do not have much "validity"
(Diener, Sandvik, Pavot, & Gallagher, 1991; McCrae & Costa,
1983; Smith, 1997). Piedmont, McCrae, Riemann, and Angleitner (2000)
have shown that validity scales do not moderate test validity and
that applying cutoff values to identify invalid protocols results
in too many false positives to justify the use of validity scales.
Also, some of the measures of response distortion used to validate
the validity scales of the TSI have been shown to reflect substantive
aspects of personality. Thus, clinical test users in general and TSI
users in particular need to be careful in interpreting scores from
such indices. Although validity scales seem to provide test users
with some reassurances that a test may be valid, such security may
not be well founded.
Briere, J. (1995). Trauma Symptom Inventory: Professional
Manual. Odessa, FL: Psychological Assessment Resources.
Briere, J., Elliott, D. M., Harris, K., & Cotman,
A. (1995). Trauma Symptom Inventory: Psychometric characteristics and
association with childhood and adult trauma in clinical samples. Journal
of Interpersonal Violence, 10, 387-401.
Diener, E., Sandvik, E., Pavot, W., & Gallagher,
D. (1991). Response artifacts in the measurement of subjective well-being.
Social Indicators Research, 24, 35-56.
McCrae, R. R., & Costa, P. T., Jr. (1983). Social
desirability scales: More substance than style. Journal of Consulting
and Clinical Psychology, 51, 882-888.
Piedmont, R. L., McCrae, R. R., Riemann, R., &
Angleitner, A. (2000). On the invalidity of validity scales: Evidence
from self-reports and observer ratings in volunteer samples. Journal of
Personality and Social Psychology, 78, 582-593.
Runtz, M. G., & Roche, D. N. (1999). Validation
of the Trauma Symptom Inventory in a Canadian sample of university women.
Child Maltreatment, 4, 69-80.
Smith, H. L. (1997). The structure and utility of
social desirability scales in psychological research. Unpublished doctoral
dissertation. University of Illinois at Urbana-Champaign.