PTSD Symptom Scale (PSS)
Name
Date_________________
(Side One)
Below is a list of traumatic events or situations. Please mark YES if you have experienced or witnessed
the following events or mark NO if you have not had that experience.
1. Serious accident, fire or explosion
Yes No
2. Natural disaster (tornado, flood, hurricane, major earthquake)
Yes No
3. Non-sexual assault by someone you know (physically attacked/injured)
Yes No
4. Non-sexual assault by a stranger
Yes No
5. Sexual assault by a family member or someone you know
Yes No
6. Sexual assault by a stranger
Yes No
7. Military combat or a war zone
Yes No
8. Sexual contact before you were age 18 with someone who was 5 or more years older than you
Yes No
9. Imprisonment
Yes No
10. Torture
Yes No
11. Life-threatening illness
Yes No
12. Other traumatic event
Yes No
13. If other traumatic event is checked YES above; please write what the event was
___________
14. Of the question to which you answered YES, which was the worst
___________
(Please list the question #)
15. Which of the above incidences is the reason for which you are currently seeking treatment?
___________
(Please list the question #)
If you answered NO to all of the above questions, STOP
If you answered YES to any of the above questions, please complete the rest of the form
Please check YES or NO regarding the event listed in question 15.
Were you physically injured?
Yes No
Was someone else physically injured?
Yes No
Did you think your life was in danger?
Yes No
Did you think someone elses life was in danger?
Yes No
Did you feel helpless?
Yes No
Did you feel terrified?
Yes No
Please complete both sides of this document if you answered YES to any of the first series of questions (1-14).
Foa, Riggs, Dancu, Rothbaum (1993)
HCSATS 2/11
PTSD Symptom Scale (PSS)
(Side 2)
Below is a list of problems that people sometimes have after experiencing a traumatic event. Please rate
on a scale from 0-3 how much or how often these following things have occurred to you in the last two
weeks:
0
1
2
3
1.
2.
3.
4.
5.
Not at all
Once per week or less/ a little bit/ one in a while
2 to 4 times per week/ somewhat/ half the time
3 to 5 or more times per week/ very much/ almost always
Having upsetting thought or images about the traumatic event that come into your
head when you did not want them to
Having bad dreams or nightmares about the traumatic event
Reliving the traumatic event (acting as if it were happening again)
Feeling emotionally upset when you are reminded of the traumatic event
6.
7.
8.
9.
10.
Experiencing physical reactions when reminded of the traumatic event (sweating,
increased heart rate)
Trying not to think or talk about the traumatic event
Trying to avoid activities or people that remind you of the traumatic event
Not being able to remember an important part of the traumatic event
Having much less interest or participating much less often in important activities
Feeling distant or cut off from the people around you
11.
12.
13.
14.
15.
16.
17.
Feeling emotionally numb (unable to cry or have loving feelings)
Feeling as if your future hopes or plans will not come true
Having trouble falling or staying asleep
Feeling irritable or having fits of anger
Having trouble concentrating
Being overly alert
Being jumpy or easily startled
Please mark YES or NO if the problems above interfered with the following:
1.
Work
Yes No
6.
Family relationships
Yes No
2.
Household duties
Yes No
7.
Sex life
Yes No
3.
Friendships
Yes No
8.
General life satisfaction
Yes No
4.
Fun/leisure activities
Yes No
9.
Overall functioning
Yes No
5.
Schoolwork
Yes No
Foa, Riggs, Dancu, Rothbaum (1993)
HCSATS 2/11
