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PTSD CheckList – Civilian Version
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For each item please indicate how much you have been bothered by that problem in the last MONTH
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Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?
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Repeated, disturbing dreams of a stressful experience from the past?
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Suddenly acting or feeling as if a stressful experience were happening again?
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Feeling very upset when something reminded you of a stressful experience from the past?
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Having physical reactions when something reminded you of a stressful experience from the past?
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** Score of 3+ to at least 1 question from questions 1-5?
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Avoid thinking about or talking about a stressful experience from the past or avoid having feelings related to it?
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Avoid activities or situations because they remind you of a stressful experience from the past?
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Trouble remembering important parts of a stressful experience from the past?
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Loss of interest in things that you used to enjoy?
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Feeling distant or cut off from other people?
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Feeling emotionally numb or being unable to have loving feelings for those close to you?
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Feeling as if your future will somehow be cut short?
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** Score of 3+ to at least 3 questions from questions 6-12?
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Trouble falling or staying asleep?
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Feeling irritable or having angry outbursts?
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Having difficulty concentrating?
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Being “super alert” or watchful on guard?
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Feeling jumpy or easily startled?
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** Score of 3+ to at least 2 questions from questions 13-17?
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Total Severity Score
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