Brief Trauma Questionnaire
The following questions ask about events that may be extraordinarily stressful or disturbing for almost everyone. Please circle “Yes” or “No” to report what has happened to you.
If you answer “Yes” for an event, please answer any additional questions that are listed on the right side of the page to report: (1) whether you thought your life was in danger or you might be seriously injured; and (2) whether you were seriously injured.
If you answer “No” for an event, go on to the next event.
Event
Has this ever happened to you?
If the event happened, did you think your life was in danger or you might be seriously injured?
If the event happened, were you seriously injured?
1. Have you ever served in a war zone, or have you ever served in
a noncombat job that exposed you to war-related casualties (for example, as a medic or on graves registration duty?)
No Yes
2. Have you ever been in a serious car accident, or a serious accident at work or somewhere else?
No Yes
3. Have you ever been in a major natural or technological disaster, such as a fire, tornado, hurricane, flood, earthquake, orchemical spill?
No Yes
4. Have you ever had a life-threatening illness such as cancer, a heart attack, leukemia, AIDS, multiple sclerosis, etc.?
No Yes N/A
5. Before age 18, were you ever physically punished or beaten by a parent, caretaker, or teacher so that: you were very frightened; or you thought you would be injured; or you received bruises, cuts, welts, lumps or other injuries?
No Yes
6. Not including any punishments or beatings you already reported in Question 5, have you ever been attacked, beaten, or mugged by anyone, including friends, family members or strangers?
No Yes
7. Has anyone ever made or pressured you into having some type of unwanted sexual contact?
Note: By sexual contact we mean any contact between someone else and your private parts or between you and some else’s private parts
No Yes
8. Have you ever been in any other situation in which you were seriously injured, or have you ever been in any other situation in which you feared you might be seriously injured or killed?
No Yes N/A
9. Has a close family member or friend died violently, for example, in a serious car crash, mugging, or attack?
No Yes N/A
10. Have you ever witnessed a situation in which someone was seriously injured or killed, or have you ever witnessed a situation in which you feared someone would be seriously injured or killed?
Note: Do not answer “yes” for any event you already reported in Questions 1-9
No Yes N/A
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.
In the past month, how much were you bothered by:
Not at all
A little bit
Moderately
Quite a bit
Extremely
1. Repeated, disturbing, and unwanted memories of the stressful experience?
0
1
2
3
4
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 reliving it)?
0
1
2
3
4
4. Feeling very upset when something reminded you of the stressful experience?
0
1
2
3
4
5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
0
1
2
3
4
6. Avoiding memories, thoughts, or feelings related to the stressful experience?
0
1
2
3
4
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
0
1
2
3
4
8. Trouble remembering important parts of the stressful experience?
0
1
2
3
4
9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me,
no one can be trusted, the world is completely dangerous)?
0
1
2
3
4
10. Blaming yourself or someone else for the stressful experience or what happened after it?
0
1
2
3
4
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?
0
1
2
3
4
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 close to you)?
0
1
2
3
4
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 harm?
0
1
2
3
4
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 (11 April 2018) National Center for PTSD