PTSD 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.

No.	
Response	Not at all
(1)	A little bit
(2)	Moderately
(3)	Quite a bit
(4)	Extremely
(5)	

1.	Repeated, disturbing memories, thoughts, or images
of a stressful experience from the past?						

2.	Repeated, disturbing dreams of a stressful experience from the past?						

3.	Suddenly acting or feeling as if a stressful experience
were happening again (as if you were reliving it)?						

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

5.	Having physical reactions (e.g., heart pounding, trouble breathing, or sweating) when something reminded you of a stressful experience from the past?						

6.	Avoid thinking about or talking about a stressful experience from the past or avoid having feelings related to it?						

7.	Avoid activities or situations because they remind you of a stressful experience from the past?						

8.	Trouble remembering important parts of a stressful experience from the past?						
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?						

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.

PTSD CheckList – Civilian Version (PCL-C)

The PCL is a standardized self-report rating scale for PTSD comprising 17 items that correspond to the key symptoms of PTSD. Two versions of the PCL exist: 1) PCL-M is specific to PTSD caused by military experiences and 2) PCL-C is applied generally to any traumatic event.

The PCL can be easily modified to fit specific time frames or events. For example, instead of asking about “the past month,” questions may ask about “the past week” or be modified to focus on events specific to a deployment.

How is the PCL completed?
The PCL is self-administered
Respondents indicate how much they have been bothered by a symptom over the past month
using a 5-point (1–5) scale, circling their responses. Responses range from 1 Not at All – 5 Extremely

How is the PCL Scored?
1) Add up all items for a total severity score
or
2) Treat response categories 3–5 (Moderately or above) as symptomatic and responses
1–2 (below Moderately) as non-symptomatic, then use the following DSM criteria for a diagnosis:
- Symptomatic response to at least 1 “B” item (Questions 1–5),
- Symptomatic response to at least 3 “C” items (Questions 6–12), and
- Symptomatic response to at least 2 “D” items (Questions 13–17)

Are Results Valid and Reliable?
Two studies of both Vietnam and Persian Gulf theater veterans show that the PCL is both valid and reliable (Additional references are available from the DHCC)

What Additional Follow-up is Available?
All military health system beneficiaries with health concerns they believe are deployment-related are encouraged to seek medical care
Patients should be asked, “Is your health concern today related to a deployment?” during all primary care visits.
• If the patient replies “yes,” the provider should follow the Post-Deployment Health Clinical Practice
Guideline (PDH-CPG) and supporting guidelines available through the DHCC and

DHCC Clinicians Helpline: 1 (866) 559-1627 DSN: 662-6563
PDH-CPG Tool Kit Pocket Cards Version 1.0 December 2003