PTSD Checklist 5 (PCL-5) PTSD Checklist 5 (PCL-5) Email address Name Date of brith Address Address Address Address Address Address Address Instructions: Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. How much you have been bothered by that problem IN THE LAST MONTH. Repeated, disturbing, and unwanted memories of the stressful experience? Not at all A little bit Moderately Quite a lot Extremely Repeated, disturbing dreams of the stressful experience? Not at all A little bit Moderately Quite a lot Extremely Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? Not at all A little bit Moderately Quite a lot Extremely Feeling very upset when something reminded you of the stressful experience? Not at all A little bit Moderately Quite a lot Extremely Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? Not at all A little bit Moderately Quite a lot Extremely Avoiding memories, thoughts, or feelings related to the stressful experience? Not at all A little bit Moderately Quite a lot Extremely Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? Not at all A little bit Moderately Quite a lot Extremely Trouble remembering important parts of the stressful experience? Not at all A little bit Moderately Quite a lot Extremely Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? Not at all A little bit Moderately Quite a lot Extremely Blaming yourself or someone else for the stressful experience or what happened after it? Not at all A little bit Moderately Quite a lot Extremely Having strong negative feelings such as fear, horror, anger, guilt, or shame? Not at all A little bit Moderately Quite a lot Extremely Loss of interest in activities that you used to enjoy? Not at all A little bit Moderately Quite a lot Extremely Feeling distant or cut off from other people? Not at all A little bit Moderately Quite a lot Extremely Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? Not at all A little bit Moderately Quite a lot Extremely Irritable behaviour, angry outbursts, or acting aggressively? Not at all A little bit Moderately Quite a lot Extremely Taking too many risks or doing things that could cause you harm? Not at all A little bit Moderately Quite a lot Extremely Being “superalert” or watchful or on guard? Not at all A little bit Moderately Quite a lot Extremely Feeling jumpy or easily startled? Not at all A little bit Moderately Quite a lot Extremely Having difficulty concentrating? Not at all A little bit Moderately Quite a lot Extremely Trouble falling or staying asleep? Not at all A little bit Moderately Quite a lot Extremely Developer Reference: Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013).The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov. Submit If you are human, leave this field blank. Δ