PTSD Symptom Self-Assessment Scale, PCL-5 Test - the question form
Questions: 20 · 4 minutes
1. In the past month, how much were you bothered by repeated, disturbing, and unwanted memories of the stressful experience?
1 – Not at all
2 – A little bit
3 – Moderately
4 – Quite a bit
5 – Extremely
2. Repeated, disturbing dreams of the stressful experience?
1 – Not at all
2 – A little bit
3 – Moderately
4 – Often
5 – Extremely
3. Suddenly feeling or acting as if the stressful experience were happening again (as if you were actually back there reliving it)?
1 – Never
2 – Rarely
3 – Moderately
4 – Often
5 – Very often
4. Feeling very upset when something reminded you of the stressful experience?
1 – Never
2 – Rarely
3 – Moderately
4 – Often
5 – Very often
5. Strong physical reactions when reminded of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
1 - Not at all
2 - A little bit
3 - Moderately
4 - Quite a bit
5 - Extremely
6. Avoiding memories, thoughts, or feelings related to the stressful experience?
1 – Not at all
2 – Rarely
3 – Moderately
4 – Quite a bit
5 – Extremely
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
1 – Never
2 – Rarely
3 – Moderately
4 – Often
5 – Very often
8. Trouble remembering important parts of the stressful experience?
1 – Not at all
2 – A little bit
3 – Moderately
4 – Quite a bit
5 – Extremely
9. Strong negative beliefs about yourself, other people, or the world (for example, thoughts such as: I am bad, something is wrong with me, no one can be trusted, the world is very dangerous)?
1 – Not at all
2 – A little bit
3 – Moderately
4 – Often
5 – Very often
10. Blaming yourself or someone else for the stressful experience or what happened afterward?
1 – Not at all
2 – A little bit
3 – Moderately
4 – Quite a bit
5 – Extremely
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?
1 – Not at all
2 – A little bit
3 – Moderately
4 – Quite a bit
5 – Extremely
12. Loss of interest in work that you used to enjoy?
1 - Never
2 - Rarely
3 - Moderately
4 - Often
5 - Very often
13. Feeling distant or cut off from other people?
Never
Rarely
Moderately
Often
Very often
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or love for people close to you)?
1 - Not at all
2 - A little bit
3 - Moderately
4 - Quite a bit
5 - Extremely
15. Irritable behavior, angry outbursts, or acting aggressively?
1 - Not at all
2 - A little bit
3 - Moderately
4 - Quite a bit
5 - Extremely
16. Taking too many risks or doing things that could cause you harm?
1 – Never
2 – Rarely
3 – Moderately
4 – Often
5 – Very often
17. Being “super alert” or watchful, or on guard?
Never
Rarely
Moderately
Often
Very often
18. Feeling nervous or frightened?
Never
Rarely
Moderately
Often
Very often
19. Trouble concentrating?
1 – Never
2 – Rarely
3 – Moderately
4 – Often
5 – Very often
20. Trouble falling asleep or staying asleep?
1 - Not at all
2 - A little bit
3 - Moderately
4 - Quite a bit
5 - Extremely