Quick check-in on PTSD

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

1. 1. Repeated, disturbing, and unwanted memories of the stressful experience?

   Not at allA little bitModeratelyQuite a bitExtremely

2. 2. Repeated, disturbing dreams of the stressful experience?

   Not at allA little bitModeratelyQuite a bitExtremely

3. 3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?

   Not at allA little bitModeratelyQuite a bitExtremely

4. 4. Feeling very upset when something reminded you of the stressful experience?

   Not at allA little bitModeratelyQuite a bitExtremely

5. 5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?

   Not at allA little bitModeratelyQuite a bitExtremely

6. 6. Avoiding memories, thoughts, or feelings related to the stressful experience?

   Not at allA little bitModeratelyQuite a bitExtremely

7. 7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?

   Not at allA little bitModeratelyQuite a bitExtremely

8. 8. Trouble remembering important parts of the stressful experience?

   Not at allA little bitModeratelyQuite a bitExtremely

9. 9. Having strong negative beliefs about yourself, other people, or the world (for example: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?

   Not at allA little bitModeratelyQuite a bitExtremely

10. 10. Blaming yourself or someone else for the stressful experience or what happened after it?

    Not at allA little bitModeratelyQuite a bitExtremely

11. 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?

    Not at allA little bitModeratelyQuite a bitExtremely

12. 12. Loss of interest in activities that you used to enjoy?

    Not at allA little bitModeratelyQuite a bitExtremely

13. 13. Feeling distant or cut off from other people?

    Not at allA little bitModeratelyQuite a bitExtremely

14. 14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?

    Not at allA little bitModeratelyQuite a bitExtremely

15. 15. Irritable behavior, angry outbursts, or acting aggressively?

    Not at allA little bitModeratelyQuite a bitExtremely

16. 16. Taking too many risks or doing things that could cause you harm?

    Not at allA little bitModeratelyQuite a bitExtremely

17. 17. Being “superalert” or watchful or on guard?

    Not at allA little bitModeratelyQuite a bitExtremely

18. 18. Feeling jumpy or easily startled?

    Not at allA little bitModeratelyQuite a bitExtremely

19. 19. Having difficulty concentrating?

    Not at allA little bitModeratelyQuite a bitExtremely

20. 20. Trouble falling or staying asleep?

    Not at allA little bitModeratelyQuite a bitExtremely

Source: Weathers, Litz, Keane, Palmieri, Marx, & Schnurr (2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD.