Scale for Clinical Diagnosis of PTSD, CAPS Test - the question form
Questions: 34 · 7 minutes
1. Have you had unwanted memories of these events that came into your mind without any reason? (Do not count memories that occurred only in dreams.) How often has this happened in the past month?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
2. Thinking of the worst of these episodes, how intense was the distress caused by these memories? Did you have to stop what you were doing? If you tried, could you push the memories away and get rid of them?
0 – No distress
1 – Low intensity: minimal distress
2 – Moderate intensity: distress is clearly present
3 – High intensity: marked distress, clear disruption in functioning, and difficulty pushing away the event-related memories
4 – Very high intensity: severe, unbearable distress, inability to continue activity, and inability to get rid of the event-related memories
3. In the past month, have you had times when you saw something that reminded you of these events and you became upset or sad? How often did this happen?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
4. Taking the worst of these episodes, how distressed or upset were you—how intense were your feelings?
0 – Not at all
1 – Mild intensity: minimal distress
2 – Moderate intensity: distress is clearly present but still manageable
3 – Severe intensity: marked distress
4 – Extreme intensity: intolerable distress
5. Have you ever suddenly acted or felt as if the event were happening again? How often has this happened to you in the past month?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
6. If you think about the worst of these episodes, how real did it feel? How strongly did it seem as if the event were happening again? How long did it last? What did you do during it?
0 – Never occurred.
1 – Mild intensity: a slightly greater sense of reality than with simply thinking about the event.
2 – Moderate intensity: definite experiences with a dissociative quality, but a close connection with the surroundings is maintained; experiences are like waking dreams.
3 – Severe intensity: markedly dissociative experiences; the patient describes images, sounds, or smells, but still retains some connection with the surrounding environment.
4 – Extreme intensity: completely dissociative experiences (flashback); no connection with current reality; may have amnesia for the episode (a “blackout”/memory gap).
7. Have you ever had distressing dreams about the event? How often has this happened in the past month?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
8. Thinking about the worst of these episodes, how intense was the distress or discomfort caused by these dreams? Did you wake up because of them?
0 – Absent
1 – Mild intensity: minimal distress; did not cause awakening
2 – Moderate intensity: wakes up distressed, but returns to sleep easily
3 – Severe intensity: very marked distress; difficulty returning to sleep
4 – Extreme intensity: overwhelming distress; unable to return to sleep
9. Have you tried to push away thoughts about the event, or made efforts to avoid feelings associated with the event (for example, anger, sadness, guilt)? How often has this happened in the past month?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
10. How much effort did you make not to think about the event or not to have feelings related to it? (Rate all deliberate attempts to avoid, including distraction, suppression, and reducing arousal by using alcohol or drugs.)
0 – No effort
1 – Mild intensity: minimal effort
2 – Moderate intensity: some effort; avoidance is definitely present
3 – Severe intensity: considerable effort; avoidance is clearly present
4 – Extreme intensity: very marked attempts to avoid
11. Have you ever tried to avoid any activities or situations that reminded you of the event?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
12. How much effort did you make to avoid activities or situations related to the event? (Rate all attempts at behavioral avoidance.)
0 – No effort
1 – Mild intensity: minimal effort
2 – Moderate intensity: some effort; avoidance is definitely present
3 – Severe intensity: considerable effort; avoidance is clearly present
4 – Extreme intensity: pronounced efforts to avoid
13. Have you had difficulty remembering important parts of the traumatic event (for example, names, faces, or the sequence of events)? In the past month, how much of what happened has been hard for you to remember?
0 – None; clear memory of the event overall
1 – Unable to remember some aspects of the event (less than 10%)
2 – Unable to remember a number of aspects of the event (20–30%)
3 – Unable to remember most aspects of the event (50–60%)
4 – Almost completely unable to remember the event (more than 80%)
14. How much effort did it take to recall important aspects of what happened to you?
0 – No difficulty recalling the event
1 – Mild intensity: slight difficulty recalling aspects of the event
2 – Moderate intensity: some difficulty, but with concentration you are able to recall the event
3 – Severe intensity: definite difficulty recalling aspects of the event
4 – Extreme intensity: complete inability to recall the event
15. Have you felt that you have lost interest in activities that used to be important or enjoyable to you (for example, sports, hobbies, socializing)? Compared with before what happened, how many types of activities have you lost interest in over the past month?
0 – No loss of interest
1 – Loss of interest in a few activities (less than 10%)
2 – Loss of interest in several activities (20–30%)
3 – Loss of interest in many activities (50–60%)
4 – Loss of interest in almost everything (more than 80%)
16. At its worst, how much did you lose interest in these activities?
0 – no loss of interest
1 – mild intensity: only slight loss of interest; does not rule out enjoyment once the activities are started
2 – moderate intensity: definite loss of interest, but some sense of enjoyment from the activities is still present
3 – severe intensity: very marked loss of interest in the activities
4 – extreme intensity: complete loss of interest; does not engage in any activities
17. Have you felt detached or estranged from other people? Was this different from how you felt before the event? How often have you felt this way in the past month?
0 – not at all
1 – rarely (less than 10% of the time)
2 – sometimes (20–30%)
3 – often (50–60%)
4 – almost always or constantly (more than 80%)
18. At its worst, how intense was your feeling of detachment or estrangement from other people? Who, if anyone, still felt close to you?
0 – No such feelings
1 – Mild intensity: intermittently feels “out of step” with other people
2 – Moderate intensity: definite feelings of distance, but some interpersonal connections and a sense of belonging are preserved
3 – Severe intensity: marked feelings of detachment or estrangement from most people; able to interact only with one person
4 – Extreme intensity: feels completely cut off from other people; maintains no close relationships with anyone
19. Have there been times when you felt emotionally numb (found it hard to have feelings such as love or happiness)? Was this different from how you felt before the event? How often have you felt this way during the past month?
0 – Not at all
1 – Rarely (less than 10% of the time)
2 – Sometimes (20–30%)
3 – Often (50–60%)
4 – Almost always or constantly (more than 80%)
20. At its worst, how intense was your feeling of emotional numbing?
0 – No emotional numbing
1 – Mild intensity: the feeling is present but slight
2 – Moderate intensity: definite feeling of emotional numbing, but the capacity to experience emotions is still preserved
3 – High intensity: marked feeling of emotional numbing with respect to at least two major emotions (e.g., love and happiness)
4 – Extreme intensity: feels a complete absence of emotions
21. Have you ever felt that there was no need to make plans for the future, as if for some reason you had “no tomorrow” (when there was no real risk or life-threatening medical diagnosis)? Was this different from how you felt before the event? How often have you felt this way during the past month?
0 – Not at all
1 – Rarely (less than 10% of the time)
2 – Sometimes (20–30%)
3 – Often (50–60%)
4 – Almost always or constantly (more than 80%)
22. In the worst case, how intense was the sense that your future would be cut short? How long did you think you would live? What made you think you might die prematurely?
0 – No sense of a foreshortened future
1 – Mild symptom intensity: slight sense of a foreshortened future
2 – Moderate symptom intensity: definite sense of a foreshortened future is present
3 – Severe symptom intensity: marked sense of a foreshortened future; may include specific premonitions about length of life
4 – Extreme symptom intensity: overwhelming sense of a foreshortened future; complete conviction of premature death
23. Have you had any problems falling asleep or staying asleep? Was this different from how you slept before the event? How often have you had sleep difficulties in the past month?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – every night (or almost every night)
24. How long does it take you to fall asleep? How often do you wake up during the night? How many hours of uninterrupted sleep do you get each night?
0 – No sleep difficulty.
1 – Mild: Some difficulty falling asleep; some difficulty maintaining sleep (sleep loss up to 30 minutes).
2 – Moderate: Definite sleep disturbance—clearly increased sleep onset latency or difficulty maintaining sleep (sleep loss of 30–90 minutes).
3 – Severe: Marked increase in sleep onset latency or major difficulty maintaining sleep (sleep loss of 90 minutes to 3 hours).
4 – Extreme: Very prolonged sleep onset latency; overwhelming difficulty maintaining sleep (sleep loss of more than 3 hours).
25. Have there been times when you felt unusually irritable or angry and acted aggressively? Was this different from how you felt or behaved before the event? How often has this happened in the past month?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
26. How intense was your anger, and how did you express it?
0 – Absent: no irritability or anger
1 – Mild intensity: minimal irritability; when angry, raised voice
2 – Moderate intensity: clear irritability; when angry, easily starts arguing but quickly calms down
3 – Severe intensity: marked irritability; when angry, verbal or behavioral aggression
4 – Extreme intensity: overwhelming anger accompanied by episodes of physical violence
27. Have you had difficulty concentrating on an activity or on things going on around you? Has your ability to concentrate changed since the event? How often have you had problems concentrating during the past month?
0 – not at all
1 – very rarely (less than 10% of the time)
2 – sometimes (20–30% of the time)
3 – most of the time (50–60% of the time)
4 – almost always or continuously (more than 80% of the time)
28. How much difficulty did you have concentrating on things?
0 – no problem
1 – mild intensity: minor effort was required to concentrate
2 – moderate intensity: some loss of ability to concentrate, but can concentrate with effort
3 – severe intensity; marked impairment in functioning, even with special effort
4 – extreme intensity: complete inability to concentrate or focus attention
29. Have you been especially alert or watchful, even when there was no obvious need? Was this different from how you felt before the event? How often in the past month have you been alert or watchful?
0 - Not at all
1 - Very rarely (less than 10% of the time)
2 - Sometimes (20-30% of the time)
3 - Most of the time (50-60%)
4 - Almost always or continuously (more than 80% of the time)
30. How much effort do you make to stay aware of everything that is going on around you?
0 – Symptom absent
1 – Mild intensity: minimal hypervigilance; slightly increased watchfulness
2 – Moderate intensity: definite hypervigilance; watchful in public places (e.g., choosing a safe seat in a restaurant or movie theater)
3 – Severe intensity: marked hypervigilance; very watchful; constantly scanning the surroundings for danger; excessive concern about personal safety (and the safety of one’s family and home)
4 – Extreme intensity: exaggerated hypervigilance; safety-related efforts require substantial time and energy and may include active checking behaviors
31. Have you had an exaggerated startle response to loud, unexpected noises (e.g., car backfires, fireworks, a slamming door) or to something you suddenly saw (e.g., movement noticed out of the corner of your eye)? Is this different from how you were before the event?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
32. At its worst, how intense was this startle response?
0 – absent: no startle response
1 – mild intensity: minimal startle response
2 – moderate intensity: definite startle response to a sudden stimulus; “jumping”
3 – severe intensity: marked startle response; continued arousal after the initial reaction
4 – extreme intensity: very pronounced startle response; clear defensive behavior
33. Have you had any physical reactions when you were exposed to situations that reminded you of the event? How often did this happen in the past month?
0 – never
1 – once or twice
2 – once or twice a week
3 – several times a week
4 – daily or almost every day
34. At its worst, how intense were these physiological reactions?
0 – Absent
1 – Mild intensity: minimal reaction
2 – Moderate intensity: clear physiological reaction; some discomfort
3 – Severe intensity: intense physiological reaction; marked discomfort
4 – Extreme intensity: dramatic physiological reaction; persistent subsequent arousal