Appendix R: Primary Care PTSD Screen for DSM-5 (PC-PTSD- 5)
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Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:
- a serious accident or fire
- a physical or sexual assault or abuse
- an earthquake or flood
- a war
- seeing someone be killed or seriously injured
- having a loved one die through homicide or suicide.
Have you ever experienced this kind of event?
YES NO
If no, screen total = 0. Please stop here.
If yes, please answer the questions below.
| In the past month have you: |
Yes |
No |
| 1. Had nightmares about the event(s) or thought about the event(s) when you did not want to? |
1 |
0 |
| 2. Tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? |
1 |
0 |
| 3. Been constantly on guard, watchful, or easily startled? |
1 |
0 |
| 4. Felt numb or detached from people, activities, or your surroundings? |
1 |
0 |
| 5. Felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? |
1 |
0 |
Source: Prins, A., Bovin, M. J., Kimerling, R., Kaloupek, D. G., Marx, B. P., Pless Kaiser, A., & Schnurr, P. P. (2016). Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) [Measurement instrument]. Available from www.ptsd.va.gov.