Below is a list of problems associated with stressful and/or traumatic events.  Indicate using the 1-5 scale of severity how much you have been bothered by the problem in the past month:

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, sweating) when something reminded you of a stressful experience from the past.
6. Avoiding thinking about or talking about a stressful experience from the past or avoiding having feelings related to it.
7. Avoiding activities or situations because they reminded 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 activities 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 or on guard.

17.

Feeling jumpy or easily startled.

This is not intended to diagnose or to replace the care of a health care professional.  This is a screening measure to help you determine whether you might have Post Traumatic Stress disorder.   Source: Weathers FW, et al. (1994). PCL-C for DSM-IV. Boston: National Center for PTSD, Behavioral Science Division. 

CO-OCCURRING DISORDERS PROGRAM: SCREENING AND ASSESSMENT.  Document is in the public domain. Duplicating this material for personal or group use is permissible.

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