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    PCL 5 Monthly

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    andrew_carlquist
    This document provides instructions for administering the PCL-5 questionnaire to assess PTSD symptoms related to a past traumatic event. It asks the respondent to briefly describe their worst or most distressing traumatic event and provides examples of events that could qualify. It then asks questions to characterize the event, such as how long ago it happened, whether it involved death, injury or violence, and how the respondent experienced it. The second page lists 20 PTSD symptoms and asks the respondent to rate how much they have been bothered by each in the past month.

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    PCL 5 Monthly

    Uploaded by

    andrew_carlquist
    130 views2 pages
    This document provides instructions for administering the PCL-5 questionnaire to assess PTSD symptoms related to a past traumatic event. It asks the respondent to briefly describe their worst or most distressing traumatic event and provides examples of events that could qualify. It then asks questions to characterize the event, such as how long ago it happened, whether it involved death, injury or violence, and how the respondent experienced it. The second page lists 20 PTSD symptoms and asks the respondent to rate how much they have been bothered by each in the past month.

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    This document provides instructions for administering the PCL-5 questionnaire to assess PTSD symptoms related to a past traumatic event. It asks the respondent to briefly describe their worst or most distressing traumatic event and provides examples of events that could qualify. It then asks questions to characterize the event, such as how long ago it happened, whether it involved death, injury or violence, and how the respondent experienced it. The second page lists 20 PTSD symptoms and asks the respondent to rate how much they have been bothered by each in the past month.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    130 views2 pages

    PCL 5 Monthly

    Uploaded by

    andrew_carlquist
    This document provides instructions for administering the PCL-5 questionnaire to assess PTSD symptoms related to a past traumatic event. It asks the respondent to briefly describe their worst or most distressing traumatic event and provides examples of events that could qualify. It then asks questions to characterize the event, such as how long ago it happened, whether it involved death, injury or violence, and how the respondent experienced it. The second page lists 20 PTSD symptoms and asks the respondent to rate how much they have been bothered by each in the past month.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    HANDOUT 3.1 (p.

    2 of 7)

    PCL-5 WITH BRIEF CRITERION A ASSESSMENT: MONTHLY


    Instructions: This questionnaire asks about problems you may have had after a very stressful
    experience involving actual or threatened death, serious injury, or sexual violence. It could be
    something that happened to you directly, something you witnessed, or something you learned
    happened to a close family member or close friend. Some examples are a serious accident; fire;
    disaster such as a hurricane, tornado, or earthquake; physical or sexual attack or abuse; war;
    homicide; or suicide.

    First, please answer a few questions about your worst event, which for this questionnaire means
    the event that currently bothers you the most. This could be one of the examples above or some
    other very stressful experience. Also, it could be a single event (for example, a car crash) or
    multiple similar events (for example, multiple stressful events in a war zone or repeated sexual
    abuse).

    Briefly identify the worst event (if you feel comfortable doing so):

    How long ago did it happen?

    Did it involve actual or threatened death, serious injury, or sexual violence?


    Yes
    No

    How did you experience it?


    It happened to me directly
    I witnessed it
    I learned about it happening to a close family member or close friend
    I was repeatedly exposed to details about it as part of my job (for example, paramedic,
    police, military, or other first responder)
    Other (please describe)

    If the event involved the death of a close family member or close friend, was it due to some kind
    of accident or violence, or was it due to natural causes?
    Accident or violence
    Natural causes
    Not applicable (the event did not involve the death of a close family member or close
    friend)

    Second, keeping this worst event in mind, read each of the problems on the next page and then
    circle one of the numbers to the right to indicate how much you have been bothered by that
    problem in the past month.
    (continued)
    PCL-5
    Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience.
    Please read each problem carefully and then circle one of the numbers to the right to indicate how much you
    have been bothered by that problem in the past month.

    Not A little Quite


    In the past month, how much were you bothered by: at all bit Moderately a bit Extremely
    1. Repeated, disturbing, and unwanted memories of the
    0 1 2 3 4
    stressful experience?
    2. Repeated, disturbing dreams of the stressful experience? 0 1 2 3 4
    3. Suddenly feeling or acting as if the stressful experience were
    actually happening again (as if you were actually back there 0 1 2 3 4
    reliving it)?
    4. Feeling very upset when something reminded you of the
    0 1 2 3 4
    stressful experience?
    5. Having strong physical reactions when something reminded
    you of the stressful experience (for example, heart pounding, 0 1 2 3 4
    trouble breathing, sweating)?
    6. Avoiding memories, thoughts, or feelings related to the
    0 1 2 3 4
    stressful experience?
    7. Avoiding external reminders of the stressful experience (for
    example, people, places, conversations, activities, objects, or 0 1 2 3 4
    situations)?
    8. Trouble remembering important parts of the stressful
    0 1 2 3 4
    experience?
    9. Having strong negative beliefs about yourself, other people,
    or the world (for example, having thoughts such as: I am 0 1 2 3 4
    bad, there is something seriously wrong with me, no one can
    be trusted, the world is completely dangerous)?
    10. Blaming yourself or someone else for the stressful
    0 1 2 3 4
    experience or what happened after it?
    11. Having strong negative feelings such as fear, horror, anger,
    0 1 2 3 4
    guilt, or shame?
    12. Loss of interest in activities that you used to enjoy? 0 1 2 3 4
    13. Feeling distant or cut off from other people? 0 1 2 3 4
    14. Trouble experiencing positive feelings (for example, being
    unable to feel happiness or have loving feelings for people 0 1 2 3 4
    close to you)?
    15. Irritable behavior, angry outbursts, or acting aggressively? 0 1 2 3 4
    16. Taking too many risks or doing things that could cause you
    0 1 2 3 4
    harm?
    17. Being “superalert” or watchful or on guard? 0 1 2 3 4
    18. Feeling jumpy or easily startled? 0 1 2 3 4
    19. Having difficulty concentrating? 0 1 2 3 4
    20. Trouble falling or staying asleep? 0 1 2 3 4

    PCL-5 (8/14/2013) Weathers, Litz, Keane, Palmieri, Marx, & Schnurr -- National Center for PTSD

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