Ptsd Checklist
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1
2PTSD CheckList
Client’s Name: __________________________________________
Instruction to patient: Below is a list of problems and complaints that veterans sometimes have in response to stressful life
experiences. Please read each one carefully, put an “X” in the box to indicate how much you have been bothered by that
problem in the last month.
Not at all
A little bit
Moderately
Quite a bit
Extremely
No.
Response
(1)
(2)
(3)
(4)
(5)
Repeated, disturbing memories, thoughts, or images
1.
of a stressful experience from the past?
Repeated, disturbing dreams of a stressful
2.
experience from the past?
Suddenly acting or feeling as if a stressful experience
3.
were happening again (as if you were reliving it)?
Feeling very upset when something reminded you of
4.
a stressful experience from the past?
Having physical reactions (e.g., heart pounding,
trouble breathing, or sweating) when something
5.
reminded you of a stressful experience from the
past?
Avoid thinking about or talking about a stressful
experience from the past or avoid having feelings
6.
related to it?
Avoid activities or situations because they remind
7.
you of a stressful experience from the past?
Trouble remembering important parts of a stressful
8.
experience from the past?
9. Loss of interest in things that you used to enjoy?
10. Feeling distant or cut off from other people?
Feeling emotionally numb or being unable to have
11.
oving 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?
PCL-M for DSM-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD - Behavioral Science Division
This is a Government document in the public domain.
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