Assessment of social functioning in combat veterans with PTSD

Maladaptive patterns of social functioning have been widely noted as core features associated with the clinical syndrome of combat-related posttraumatic stress disorder (PTSD), including interpersonal violence, social anxiety and avoidance, marital/family discord, and occupational impairment. Unfortunately, clinical instruments for evaluating the complex domains of social functioning are lacking, and no measures have been developed specifically for combat-related PTSD. Therefore, the development of reliable and valid procedures for assessing the social functioning of this group is sorely needed. A number of strategies currently exist, including symptom severity, symptom chronicity, and monetary gain incentive; however, assessment of this population represents several unique challenges. Until measures of social functioning are developed and validated specifically for combat-related PTSD, comprehensive assessment should consist of a multimethod approach, including (a) self-report measures; (b) structured interviews and clinician ratings; (c) patient ratings (e.g., daily diaries); (d) behavioral performance assessments of social skill strengths and deficits; and (e) other behavioral assessments, including functional analysis, psychophysiological measurements, and objective indicators of functioning. The development of an endstate functioning index, anchored to a normal population, would advance our ability to gage the social functioning of veterans following treatment.