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PTSD Checklist for DSM-5 (PCL-5)

Screens adults who have been through a very stressful experience for PTSD symptoms over the past month.

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Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

Your Experience

  1. Thank you for taking part. This questionnaire asks about problems people sometimes have after going through something very stressful. Your answers are confidential.

  2. This questionnaire uses the PTSD Checklist for DSM-5 (PCL-5) by F. W. Weathers, B. T. Litz, T. M. Keane, P. A. Palmieri, B. P. Marx and P. P. Schnurr (2013), National Center for PTSD. It is in the public domain.

  3. Your result is a screening aid, not a diagnosis. Only a qualified professional can diagnose PTSD. If you feel unsafe or overwhelmed, please contact a health professional or a local crisis service.

  4. Have you ever been through a very stressful experience, such as an accident, an assault, a disaster, combat or the sudden loss of someone close, that still stays with you?

    Choose one:

    • Yes
    • No

  5. About how long ago did this experience happen? If there was more than one, think of the one that troubles you most.

    Condition: Only for those who report a very stressful experience

    Choose one:

    • Less than 1 month ago
    • 1 to 6 months ago
    • 6 to 12 months ago
    • More than 1 year ago

  6. The rest of this questionnaire is about reactions to a very stressful experience, so there is nothing more for you to answer. Thank you for your time.

Memories and Reminders

  1. Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then select the answer that indicates how much you have been bothered by that problem in the past month.

  2. In the past month, how much were you bothered by:

    Condition: Only for those who report a very stressful experience

    • Repeated, disturbing, and unwanted memories of the stressful experience?
    • Repeated, disturbing dreams of the stressful experience?
    • Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
    • Feeling very upset when something reminded you of the stressful experience?
    • Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?

    For each row: choose one:

    • Not at all
    • A little bit
    • Moderately
    • Quite a bit
    • Extremely

Avoidance

  1. In the past month, how much were you bothered by:

    Condition: Only for those who report a very stressful experience

    • Avoiding memories, thoughts, or feelings related to the stressful experience?
    • Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?

    For each row: choose one:

    • Not at all
    • A little bit
    • Moderately
    • Quite a bit
    • Extremely

Thoughts and Feelings

  1. In the past month, how much were you bothered by:

    Condition: Only for those who report a very stressful experience

    • Trouble remembering important parts of the stressful experience?
    • 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)?
    • Blaming yourself or someone else for the stressful experience or what happened after it?
    • Having strong negative feelings such as fear, horror, anger, guilt, or shame?
    • Loss of interest in activities that you used to enjoy?
    • Feeling distant or cut off from other people?
    • Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?

    For each row: choose one:

    • Not at all
    • A little bit
    • Moderately
    • Quite a bit
    • Extremely

Alertness and Reactions

  1. In the past month, how much were you bothered by:

    Condition: Only for those who report a very stressful experience

    • Irritable behavior, angry outbursts, or acting aggressively?
    • Taking too many risks or doing things that could cause you harm?
    • Being "superalert" or watchful or on guard?
    • Feeling jumpy or easily startled?
    • Having difficulty concentrating?
    • Trouble falling or staying asleep?

    For each row: choose one:

    • Not at all
    • A little bit
    • Moderately
    • Quite a bit
    • Extremely