571/545 Avenue K SE, Winter Haven FL 33880Mon-Fri: 9am-6pm | Walk-Ins: 9am-2pm | Sat-Sun: Appointment only
Call: 407-440-0708
Clinical Screening

PTSD Checklist for DSM-5 (PCL-5)

Below is a list of problems people sometimes have in response to a very stressful experience. Indicate how much you have been bothered by each in the past month. 0 = not at all, 4 = extremely.

Patient Information

Questions (past month)

Score: 0/80

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

2. Repeated, disturbing dreams of the stressful experience?

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

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

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

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

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

8. Trouble remembering important parts of the stressful experience?

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, nobody can be trusted, the world is completely dangerous)?

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

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

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

13. Feeling distant or cut off from other people?

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

15. Irritable behavior, angry outbursts, or acting aggressively toward other people?

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

17. Being 'super alert' or watchful on guard?

18. Feeling jumpy or easily startled?

19. Having difficulty concentrating?

20. Trouble falling or staying asleep?

Patient Signature