PTSD Checklist for DSM-5 (PCL-5)
Complete this assessment to help evaluate PTSD symptoms. Please answer each question based on your experience in the past month.
Client Full Name
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First Name
Last Name
Assessment Date
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Month
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Day
Year
Date
In the past month, how much were you bothered by: 1. Repeated, disturbing, and unwanted memories of the stressful experience?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
2. Repeated, disturbing dreams of the stressful experience?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
4. Feeling very upset when something reminded you of the stressful experience?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
6. Avoiding memories, thoughts, or feelings related to the stressful experience?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
8. Trouble remembering important parts of the stressful experience?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
9. 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)?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
10. Blaming yourself or someone else for the stressful experience or what happened after it?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
12. Loss of interest in activities that you used to enjoy?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
13. Feeling distant or cut off from other people?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
15. Irritable behavior, angry outbursts, or acting aggressively?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
16. Taking too many risks or doing things that could cause you harm?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
17. Being 'superalert,' watchful, or on guard?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
18. Feeling jumpy or easily startled?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
19. Having difficulty concentrating?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
20. Trouble falling or staying asleep?
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Not at all
A little bit
Moderately
Quite a bit
Extremely
Total PCL-5 Score
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