Transcription of PTSD Checklist (PCL)
1 17 Document is in the public domain. Duplicating this material for personal or group use is DISORDERS PROGRAM: SCREENING AND ASSESSMENTPTSD Checklist (PCL)Page 1 of 1If an event listed on the Life Events Checklist happened to youor you witnessed it,please complete theitems below. If more than one event happened, please choose the one that is most troublesome to you event you experienced was_____ :Below is a list of problems and complaints that people sometimes have in response to stress-ful life experiences. Please read each one carefully, then circleone of the numbers to the right to indicatehow much you have been botheredby the problem in the past LITTLEBITNOT AT ALLBOTHERED BYMODERATELYQUITE A BITEXTREMELY1. Repeated disturbing memories, thoughts, or images of the stressful experience?
2 123452. Repeated, disturbing dreams of the stressful experience?123453. Suddenly acting or feeling as if the stressful experience were happening again (as if you were reliving it)?123454. Feeling very upset when something reminded you of the stressful experience?123455. Having physical reactions ( , heart pounding, trouble breathing, or sweating) when something reminded you of the stressful experience?123456. Avoiding thinking about or talking about the stressful experience or avoiding having feelings related to it?123457. Avoiding activities or situations because they remind you of the stressful experience?123458. Trouble remembering important parts of the stressful experience?123459. Loss of interest in activities that you used to enjoy?1234510. Feeling distant or cut off from other people?
3 1234511. Feeling emotionally numb or being unable to have loving feelings for those close to you?1234512. Feeling as if your future will somehow be cut short?1234513. Trouble falling or staying asleep?1234514. Feeling irritable or having angry outbursts?1234515. Having difficulty concentrating?1234516. Being super alert or watchful or on guard?1234517. Feeling jumpy or easily startled?12345(EVENT)(DATE)Patient Name:_____Date:_____
