The City of Toronto is starting construction on Ossington Avenue on March 27 until the end of May 2023. During the duration of construction, Ossington Avenue from Argyle Street to Queen Street will be reduced to south bound only for vehicles.

Learn more

If you are in an emergency, in crisis or need someone to talk to, there is help.

View Crisis Resouces
Skip to content
  • Contact Us
  • No One Left Behind
  • Join our team
  • Vaccine Clinic
  • Accessibility
CAMH logo
  • Your Care
    • Main Page
    • Access CAMH & Referral Form
      • Access CAMH

        Centralized information, intake and scheduling. Access CAMH makes it easy to find support – simply call 416-535-8501, option 2.

      • Referral Form

        For mental health services, a referral form needs to be completed by a healthcare provider. For addictions services, patient can self-refer.

    • Programs & Services
      • Addictions/Substance Use
      • Aggression & Behavioural Issues
      • Alzheimer’s & Dementia
      • Anxiety & Depression
      • Concurrent Disorders
      • Developmental Disabilities
      • Mood & Personality Disorders
      • Problem Gambling
      • Schizophrenia & Psychosis
      • Trauma & Stress Disorders
      • Virtual Mental Health and Outreach
      • Other
    • Patient Wellness
    • Planning Your Care
      • Supporting Families

        Family members play an essential role the recovery of a loved one. The Office of Family Engagement is here for you.

      • Staying at CAMH

        Be prepared with all the info you need to make your inpatient experience at CAMH as comfortable as possible.

    • Your Rights
      • Client Relations
      • Bill of Client Rights
      • Empowerment Council
      • Legal Rights, Protection of Health Info & Access to Records
    • Visiting CAMH
      • Visiting CAMH

        Planning on visiting CAMH? Find contact information, directions and accessibility for each of our three main sites.

        Read More
  • Health Info
    • Main Page
    • Mental Illness & Addiction Index
      • Conditions & Disorders
      • Medication Therapies
      • Substance Use
      • Types of Treatment
      • Information in Other Languages
    • Mental Health 101
      • Mental Health 101

        Use this series of free online tutorials as the starting point to learn about and understand a wide range of mental health topics.

        Read More
    • Guides & Publications
      • Guides & Publications

        Accessible, reliable, professionally produced resources on an array of mental health topics for patients, families, students and professionals.

        Read More
    • Crisis Resources
      • Crisis Resources

        If you are in an emergency, in crisis or need someone to talk to, there is a list of resources available for areas in and around Toronto.

        Read More
    • CAMH Store
      • CAMH Store

        The CAMH Store offers a wide array of mental illness and addiction resources for patients, families, students and professionals. Search or browse our catalogue of brochures and booklets, textbooks, manuals and assessment tools.

        Read More
    • CAMH Library
      • CAMH Library

        Open to professionals and the general public, our comprehensive resources and services support and enhance CAMH's research and clinical programs, and they facilitate learning, dynamic knowledge exchange and health promotion initiatives.

        Read More
    • Workplace Mental Health Playbook
    • Mental Health and the COVID-19 Pandemic
      • Coping with stress & anxiety
      • Quarantine & isolation
      • Stigma and prejudice
      • Loss, grief and healing
      • Resources for Health Care Workers
  • Research
    • Main Page
    • Research Areas at CAMH
      • Brain Science

        CAMH is revolutionizing our understanding of the brain and the causes, biomarkers and treatments of mental illness.

      • Personalized Care

        By understanding diverse groups, we prevent, diagnose and care for each one with greater precision and personalization.

      • Prevention and Policy

        Using evidence, we drive system and social change to optimize care and reduce the burden of mental illness, including addictions, across populations.

    • The Discovery Fund
      • The Discovery Fund

        Fuelling the next generation of groundbreaking research and innovation dedicated to finding the causes of and cures for mental illness.

        Read More
    • Institutes & Centres
      • Azrieli Adult Neurodevelopmental Centre
      • Azrieli Centre for Neuro-Radiochemistry
      • Brain Health Imaging Centre
      • Campbell Family Mental Health Research Institute
      • Centre for Youth Bipolar Disorder
      • Cundill Centre for Child and Youth Depression
      • Institute for Mental Health Policy Research
      • Krembil Centre for Neuroinformatics
      • Slaight Family Centre for Youth in Transition
      • Tanenbaum Centre for Pharmacogenetics
      • Temerty Centre for Therapeutic Brain Intervention
      • The Margaret and Wallace McCain Centre for Child Youth & Family Mental Health
    • Clinical Divisions
      • Addictions Division
      • Adult Neurodevelopmental and Geriatric Psychiatry Division
      • Child and Youth Psychiatry Division
      • Forensic Psychiatry Division
      • General and Health Systems Psychiatry Division
      • Psychology Division
      • Schizophrenia Division
    • Research Discoveries
      • Research Discoveries

        At the leading edge of breakthrough mental health and addiction research for over 50 years.

      • BrainBuzz Newsletter

        The latest news, groundbreaking discoveries and special features about CAMH research, studies, and the people behind the work.

      • Research Strategic Plan

        Learn what drives our research agenda and priorities in the CAMH Research Plan for 2018-2023

    • Research Connect
      • Research Connect FAQs
      • Research Ethics
    • Research Students & Fellows
      • Research Students & Fellows

        Train in a unique and welcoming learning environment with Canada's leading scientists in mental illness and addiction.

        Read More
    • Science & Research Staff Directory
      • Our Scientific Staff
      • Research Chairs at CAMH
    • Tech Transfer & Industry Partnerships
  • Education
    • Main Page
    • Continuing Education Programs and Courses
      • Find the Course That's Right for You

        Browse our entire selection of certificate programs, webinars and workshops.

      • Workplace Education and Consulting

        View our full list of workplace mental health workshops and consulting services

    • Collaborative Learning College
    • Simulation Centre
    • Student Centre
    • Clinical & Research Opportunities for Professionals in Training
      • Clinical Psychology Training Programs
      • Community-Based Research Fellowship
      • Graduate & Post-Doctoral Fellowships in Public Health Policy
      • Clinical & Research Opportunities for Professionals in Training

        Study in a world-class setting to become a leader in the field of mental health.

    • Academic & Education Research Excellence
      • Academic & Education Research Excellence

        Inspired teaching fosters inspired learning – CAMH improves the quality of care for all through excellence in professional education.

        Read More
    • CAMH Business Development Office Contacts
    • CAMH Education Contacts
  • Professionals _
    • Main Page
    • Treating Conditions and Disorders
      • Adult ADHD
      • Anxiety Disorders
      • Canadian Opioid Use Disorder Guideline
      • Dementia
      • Depression
      • Disability & insurance claims in primary care
      • Eating Disorders
      • Fundamentals of Addiction
      • Intellectual & Developmental Disabilities
      • Mania
      • OCD
      • Perinatal Mood & Anxiety Disorders
      • Personality Disorders
      • Psychosis
      • Posttraumatic Stress Disorder
      • Sleep Disorders
      • Smoking Cessation
      • Suicide Risk
      • Psychiatric Interviewing
      • The CARIBOU Pathway by CAMH
    • Professionals Projects
      • Immigrant and Refugee Mental Health Project
      • Opioid Use in Primary Care Conference 2023
    • Videos
    • Podcasts
  • Get Involved
    • Main Page
    • Ways to Donate
      • Give Monthly
      • Give In Memory or In Honour
      • Explore the Giving Hub
      • Start a Fundraiser
      • Gifts of Celebration
      • Leave a Gift in Your Will
      • Employee Matching & Payroll Deduction
      • Donate Goods & Services
      • Gifts of Securities
      • Canvassers & Callers
      • Make a one-time donation

        With your support, CAMH researchers are revolutionizing the ways we diagnose, treat, and prevent mental illness. Donate today.

    • Join the Cause
      • Business Leaders for Mental Health Action
      • Visionary Society
      • Michael Wilson Society
      • CAMH Engage
      • Corporate Partnerships
      • Volunteer at CAMH
    • Putting Your Donations to Work
      • Putting Your Donations to Work

        Every donation you make to CAMH enables us to directly help Canadians living with mental illness— and countless more worldwide—through the discoveries we share.

        Read More
    • Making a Real Impact
      • Making a Real Impact

        Real stories of courage, hope and discovery. Made possible through your continued support of CAMH.

        Read More
  • Driving Change
    • Main Page
    • About CAMH
      • Leadership Team Directory
      • Performance & Accountability
      • The Role of CAMH Foundation
      • For Reporters
      • Events Calendar
      • For Our Neighbours
      • Contact CAMH
      • One CAMH: Strategic Plan 2020-2023
      • Careers at CAMH

        Interested in working at CAMH and making a difference? Put your skills and passion to work in a dynamic, supportive environment—and help transform lives and the future of mental health care.

    • The Crisis is Real
      • The Crisis is Real

        We are in the grips of a crisis that ruins health, threatens lives and hurts economies. Knowing the facts is the first step in creating hope.

      • Mental Health Statistics

        The latest facts and statistics on mental illness and addiction, who's affected and their impact on Canadians.

    • Addressing Stigma
      • Addressing Stigma

        Challenging the stigma associated with mental illness takes understanding, education and a closer look at our own attitudes toward health.

        Read More
    • The Mental Health Facility of the Future
      • The Mental Health Facility of the Future

        Turning what was once a walled institution into a symbol of hope for the future of mental health care.

      • Vision & Guiding Principles

        How do you replace an institution with an urban village? Lots of planning, imagination and a long-term commitment to serving patients, staff and the community.

      • History of Queen Street Site

        Our history—evolving from an asylum into a modern health facility with patients at the centre of care—is the history of mental health care in Canada.

    • Provincial System Support Program
      • Provincial System Support Program

        CAMH’s Provincial System Support Program collaborates to support the province’s Mental Health and Addictions Strategy and make sustainable, system-level change.

        Read More
    • Influencing Public Policy
      • Influencing Public Policy

        CAMH advocates for policies that are responsive to the needs of people with mental illness and addictions.

        Read More
    • Health Equity
      • Health Equity

        CAMH believes in the principle of equity. We respect the diversity of the individuals and communities we serve.

        Read More
    • Game Changers
    • Shkaabe Makwa
    • CAMH News & Stories
    • Contact Us
    • No One Left Behind
    • Join our team
    • Vaccine Clinic
    • Accessibility

PTSD: Screening & Assessment

CAMH Logo
  • PTSD: Screening & Assessment
Back to top
  • Home
  • Professionals
  • Treating Conditions and Disorders
  • Posttraumatic Stress Disorder
  • Screening & Assessment
CAMH logo
  • Posttraumatic Stress Disorder
  • Screening & Assessment
  • Diagnosis
  • Treatment
  • Clinical Tools
Back to top

Text adapted from: "The adult patient with a posttraumatic stress disorder," in Psychiatry in primary care   by Francesca L. Schiavone and Ruth A. Lanius (CAMH, 2019).

Posttraumatic Stress Disorder Checklist (PCL-5)

The Posttraumatic Stress Disorder Checklist  (PCL-5)  is a 20-item self-report tool that corresponds to the 20 symptoms listed in DSM-5 (Blevins et al., 2015). It can provide a global assessment of PTSD severity both at the time of diagnosis and over the course of treatment. 

PCL-5
Self-report tool that assesses PTSD severity at the time of diagnosis and over the course of treatment.

Print Version

On a 4-point scale, scores can be tabulated for individual items to give information about the severity of the four DSM-5 symptom clusters. If a score of 2 (moderate) is considered to be a positive endorsement of a given criterion, the PCL-5 can be used in combination with a clinical interview to make a provisional DSM-5 diagnosis. Testing the PCL-5 with veterans has determined a score of 31 to 33 to be a valid cutoff for a positive screen, but more work is necessary to validate this score in civilian populations (Bovin et al., 2016). 

Dissociative Experiences Scale

Because the DSM-5 incorporates a dissociative subtype of PTSD, it is useful to screen for dissociative symptoms, which are not captured by the PCL-5.


Dissociative Experiences Scale - II (DES-II)

Print Version

Online Version

The self-report Dissociative Experiences Scale (DES)  asks respondents to rate what percentage of the time they experience a given dissociative symptom (Bernstein & Putnam, 1986). The general population average is 4 to 8 percent compared with 26 to 42 percent among people with PTSD (Carlson & Putnam, 1993). The DES cannot be used for diagnosis, but scoring over 20 per cent indicates the need to further explore dissociative symptoms (Lanius et al., 2016).

Clinical Presentation

The first diagnostic criterion for PTSD is having experienced a traumatic event, which DSM-5 defines as “exposure to actual or threatened death, serious injury, or sexual violence” (APA, 2013). The person must experience symptoms across four clusters: intrusions, avoidance, negative alterations in mood or cognition, and alterations in arousal. Symptoms must be present for more than one month and result in significant distress or impairment. (See Diagnosis for full DSM-5 diagnostic criteria.)

In DSM-5, PTSD is no longer classified as an anxiety disorder. It has been moved into a new category called “trauma and stressor-related disorders.” This separate classification acknowledges that not all people with PTSD have a presenting complaint related to anxiety. PTSD may also present as profound dysphoria and anhedonia, significant irritability and behavioural reactivity, or persistent dissociation and detachment.

Other common presentations include low mood, anxiety and panic, specific phobias, anger problems, insomnia or nightmares, interpersonal difficulties, occupational dysfunction and emotional numbness. The person may experience prominent feelings of guilt and shame, and a sense of “moral injury.” In military populations, guilt and shame are associated with later development of PTSD (Nazarov et al., 2015).

PTSD may also present as somatic symptoms and frequent use of the medical system. A study of primary care patients who met criteria for PTSD found poorer overall health functioning and higher rates of using health care services (Gillock et al., 2005).

Complex Trauma

The heterogeneity in the clinical presentation of PTSD can be partly explained by significant differences in the types, patterns and timing of traumatic events. The impact of a single event in adulthood is different from the impact of repeated childhood sexual or physical victimization or neglect by a primary caregiver. Because the latter occurs repeatedly during critical developmental periods, it interrupts or prevents normal developmental tasks such as consolidating identity, forming basic trust in others and learning affect regulation skills (Glaser, 2000; Herman, 1997).

People with such complex traumatization are more likely to present with dissociative symptoms, somatization, extensive comorbidity, intense suicidality, and alterations in identity and interpersonal relatedness. People with a history of complex trauma are more likely to develop symptoms after subsequent adulthood trauma (Herman, 1997; Lanius et al., 2016).

Dissociation

Many of the symptoms captured in the core diagnostic criteria for PTSD represent hyperarousal symptoms, or under-modulation of the central nervous system in response to trauma-related cues. However, 15 to 30 percent of people with PTSD, particularly those with chronic childhood traumatization, have over-modulated traumatic emotions and responses, manifested as dissociative symptoms (Lanius et al., 2016).

Dissociation is “a disruption of the usually integrated functions of consciousness, memory, identity, or awareness of body, self, or environment” (APA, 2013). This definition encompasses the depersonalization and derealization symptoms identified in the PTSD dissociative subtype (feeling detached from the self or environment).

Dissociation can also include memory impairment, particularly loss of memory of traumatic events; reduced response to the environment (physical and emotional numbness); spontaneous “trancing” or “spacing out”; and identity confusion or fragmentation (Lanius et al., 2016).


In PTSD

  • The Primary Care Practitioner Role
  • Screening & Assessment
  • Diagnosis
  • Treatment
    • Pharmacotherapy
  • Clinical Tools
  • Resources and References

Related

  • Trauma: Health Information for your Patient

    Read More

  • Psychiatry in Primary Care: A Concise Canadian Pocket Guide 2019

    Read More

  • Posttraumatic Stress Disorder: A CAMH Pamphlet

    Read More

  • The Immigrant and Refugee Mental Health Project: Resources for Professionals

    Read More

Overview
Diagnosis

Follow us
  • Your Care
  • Health Info
  • Science and Research
  • Education
  • Professionals
  • Get Involved
  • Driving Change
  • About CAMH
  • Job Openings
  • Purchase Publications
  • Referral Form
  • For Reporters
  • Donor Services
  • Events

CAMH Switchboard

From the GTA: 416 535-8501


Toll-free: 1 800 463-2338

To Access CAMH Clinical Services

416 535-8501, press 2

We have multiple locations. Find directions.

Map of CAMH's Queen Street Site
  • Staff Tools

Copyright 2023 CAMH

  • Terms of Use
  • Accessibility
  • Site Map

Keep in touch with CAMH

Keep your finger on our pulse – latest CAMH news, discoveries and ways to get involved delivered to your inbox.

Please select a newsletter

Please complete the following:

    Required Fields

    Please select a newsletter option

    Please input a first name

    Please input a last name

    Please input an email address

    By clicking Sign Up below, I consent to receive electronic communications (as selected above) from CAMH and CAMH Foundation. To unsubscribe at any time click the link in our mailing or email: unsubscribe@camh.ca

    Please agree to the Terms of Use

     

    Thanks for Subscribing.

    We look forward to keeping you informed, inspired and involved in all things CAMH.

    Give for a world where mental health is health

    Your donation will fund the groundbreaking mental health research that is helping people on the path to recovery.

    $
    Other Ways to Give