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    PCL5 Standard Form Week

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    D. Gabon
    This document is the PTSD Checklist for DSM-5 (PCL-5), which is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. It contains a list of problems that people sometimes have in response to a stressful life event, and asks respondents to indicate how much they have been bothered by each problem in the past month on a scale of 0 to 4. The checklist can be used to provisionally diagnose PTSD and to monitor symptom change during and after treatment.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    PCL5 Standard Form Week

    Uploaded by

    D. Gabon
    43 views3 pages
    This document is the PTSD Checklist for DSM-5 (PCL-5), which is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. It contains a list of problems that people sometimes have in response to a stressful life event, and asks respondents to indicate how much they have been bothered by each problem in the past month on a scale of 0 to 4. The checklist can be used to provisionally diagnose PTSD and to monitor symptom change during and after treatment.

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    PCL5_Standard_form_week

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    This document is the PTSD Checklist for DSM-5 (PCL-5), which is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. It contains a list of problems that people sometimes have in response to a stressful life event, and asks respondents to indicate how much they have been bothered by each problem in the past month on a scale of 0 to 4. The checklist can be used to provisionally diagnose PTSD and to monitor symptom change during and after treatment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    43 views3 pages

    PCL5 Standard Form Week

    Uploaded by

    D. Gabon
    This document is the PTSD Checklist for DSM-5 (PCL-5), which is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. It contains a list of problems that people sometimes have in response to a stressful life event, and asks respondents to indicate how much they have been bothered by each problem in the past month on a scale of 0 to 4. The checklist can be used to provisionally diagnose PTSD and to monitor symptom change during and after treatment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    PTSD Checklist for

    DSM-5 (PCL-5)
    (Past Week Version)

    Version date: 29 August 2023


    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) – Standard
    [Measurement instrument]. Available from
    https://www.ptsd.va.gov/
    URL: https://www.ptsd.va.gov/professional/
    assessment/adult-sr/ptsd-checklist.asp
    Note: This is a fillable form. You may complete it electronically.
    This page intentionally left blank
    PCL-5
    Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience.
    Keeping your worst event in mind, please read each problem carefully and then select one of the numbers to the right
    to indicate how much you have been bothered by that problem in the past month.

    Your worst event: ________________________________________________________________________________

    In the past month, how much were you bothered by: Not at all A little bit Moderately Quite a bit Extremely
    1. Repeated, disturbing, and unwanted memories of the
    0 1 2 3 4
    stressful experience?
    2. Repeated, disturbing dreams of the stressful experience? 0 1 2 3 4
    3. Suddenly feeling or acting as if the stressful experience
    were actually happening again (as if you were actually 0 1 2 3 4
    back there reliving it)?
    4. Feeling very upset when something reminded you of the
    0 1 2 3 4
    stressful experience?
    5. Having strong physical reactions when something
    reminded you of the stressful experience (for example, 0 1 2 3 4
    heart pounding, trouble breathing, sweating)?
    6. Avoiding memories, thoughts, or feelings related to the
    0 1 2 3 4
    stressful experience?
    7. Avoiding external reminders of the stressful experience
    (for example, people, places, conversations, activities, 0 1 2 3 4
    objects, or situations)?
    8. Trouble remembering important parts of the stressful
    0 1 2 3 4
    experience?
    9. Having strong negative beliefs about yourself, other
    people, or the world (for example, having thoughts such as:
    0 1 2 3 4
    I am bad, there is something seriously wrong with me, no
    one can be trusted, the world is completely dangerous)?
    10. Blaming yourself or someone else for the stressful
    0 1 2 3 4
    experience or what happened after it?
    11. Having strong negative feelings such as fear, horror, anger,
    0 1 2 3 4
    guilt, or shame?
    12. Loss of interest in activities that you used to enjoy? 0 1 2 3 4
    13. Feeling distant or cut off from other people? 0 1 2 3 4
    14. Trouble experiencing positive feelings (for example,
    being unable to feel happiness or have loving feelings for 0 1 2 3 4
    people close to you)?
    15. Irritable behavior, angry outbursts, or acting aggressively? 0 1 2 3 4
    16. Taking too many risks or doing things that could cause
    0 1 2 3 4
    you harm?
    17. Being “superalert” or watchful or on guard? 0 1 2 3 4
    18. Feeling jumpy or easily startled? 0 1 2 3 4
    19. Having difficulty concentrating? 0 1 2 3 4
    20. Trouble falling or staying asleep? 0 1 2 3 4

    PCL-5 (18 August 2023) National Center for PTSD Page 3 of 3

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