Ptsd Checklist - Military Version (Pcl-M) Template
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1PTSD Checklist – Military Version (PCL-M)
Name: _______________________________ Unit: ______________________
Best contact number and/or email: ____________________________________
Deployed location: _________________________________________________
Instructions: Below is a list of problems and complaints that veterans sometimes have in
response to a stressful military experience. Please read each one carefully, put an “X” in the box.
Not at all
A little bit
Moderately
Quite a bit
Extremely
1.
Repeated, disturbing memories, thoughts, or images
of a stressful military experience?
2.
Repeated, disturbing dreams of a stressful military
experience?
3.
Suddenly acting or feeling as if a stressful military
experience were happening again (as if you were
reliving it)?
4.
Feeling very upset when something reminded you
of a stressful military experience?
5.
Having physical reactions (e.g., heart pounding,
trouble breathing, or sweating) when something
reminded you of a stressful military experience?
6.
Avoid thinking about or talking about a stressful
military experience or avoid having feelings related
to it?
7.
Avoid activities or talking about a stressful military
experience or avoid having feelings related to it?
8.
Trouble remembering important parts of a stressful
military experience?
9.
Loss of interest in things that you used to enjoy?
10.
Feeling distant or cut off from other people?
11.
Feeling emotionally numb or being unable to have
loving feelings for those close to you?
12.
Feeling as if your future will somehow be cut short?
13.
Trouble falling or staying asleep?
14.
Feeling irritable or having angry outbursts?
15.
Having difficulty concentrating?
16.
Being “super alert” or watchful on guard?
17.
Feeling jumpy or easily startled?
Has anyone indicated that you’ve changed since the stressful military experience? Yes __ No__
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