Combat Exposure Scale (CES)
Combat Exposure Scale · Also known as: CES, Keane Combat Exposure Scale
The CES is a 7-item self-report measure of combat exposure developed by Keane and colleagues in 1989. It quantifies the frequency and intensity of combat experiences, including direct fire, causalities witnessed, and hazardous mission environments. It is widely used in veteran research and clinical screening to characterize trauma load and risk for PTSD.
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When to use it
The CES is used in: (1) veteran epidemiological research to characterize combat exposure patterns across cohorts, (2) clinical research examining the dose–response relationship between exposure and mental health outcomes, (3) military medical settings to contextualize PTSD symptom severity within documented exposure history, (4) neurobiological studies investigating effects of combat trauma on brain structure/function. It is most appropriate for populations with confirmed combat/military service. It is less suitable for other trauma types (e.g., civilian violence, accidents) unless adapted.
Strengths & limitations
- Brief, intuitive items with minimal burden; respondents easily recall combat events and frequency
- Good internal consistency (α = 0.77–0.80) and test–retest reliability (r = 0.80–0.84)
- Dimensional scoring permits fine-grained assessment across exposure spectrum; not binary
- Modest convergent validity with objective military records (e.g., unit deployment records); somewhat resistant to recall bias
- Extensively used in VA research, enabling cross-study comparison and synthesis
- No validated categorical cutoffs; interpretation is necessarily dimensional and context-dependent
- Relies on self-report and retrospective recall; subject to underreporting (e.g., minimization due to shame) and overreporting (e.g., social desirability)
- Modest correlation with PTSD severity (r = 0.40–0.55); exposure is a necessary but insufficient predictor of symptoms (resilience varies)
- Does not capture qualitative nature of exposure (e.g., moral injury from civilian casualties vs. direct combat threat); focus is on frequency/intensity, not meaning
- Limited validity outside combat-deployed military; not validated in police, firefighters, or civilian trauma
Frequently asked
What CES score indicates 'high' combat exposure?
No validated cutoff exists. Median scores in deployed units are typically 10–20. Scores >25 reflect substantial exposure (frequent direct fire or multiple threat incidents); >30 indicates very heavy exposure. However, interpretation is context-dependent (infantry vs. support roles have different norms).
Can I use CES in non-military trauma survivors (e.g., police, firefighters)?
CES is designed for and validated in combat-exposed military personnel. It has not been systematically validated in police or firefighter samples. Alternative measures of occupational trauma exposure may be more appropriate for non-military first responders.
How does CES relate to PTSD diagnosis?
CES is not diagnostic and does not replace PTSD symptom measures (e.g., PCL-M). CES and PCL-M are moderately correlated (r ≈ 0.40–0.55), reflecting that exposure is a risk factor but not a determinant of PTSD. High exposure does not guarantee PTSD; low exposure does not exclude it.
Is CES free and copyright-protected?
CES is in the public domain and freely available from the National Center for PTSD (va.gov). No copyright restrictions or licensing fees apply.
Sources
- Keane, T. M., Fairbank, J. A., Caddell, J. M., Zimering, R. T., Taylor, K. L., & Mora, C. A. (1989). Clinical evaluation of a measure to assess combat exposure. Psychological Assessment, 1(1), 53-55. DOI: 10.1037/1040-3590.1.1.53 ↗
- Keane, T. M., Caddell, J. M., & Taylor, K. L. (1988). Mississippi Scale for Combat-Related PTSD: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56(1), 85-90. DOI: 10.1037/0022-006x.56.1.85 ↗
How to cite this page
ScholarGate. (2026, June 3). Combat Exposure Scale. ScholarGate. https://scholargate.app/en/military-psychology/combat-exposure-scale
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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