The rater scored this item incorrectly. All ratings are correct except the severity score, which should be: 3 Severe/markedly elevated.

Rationale: Brian also describes extreme distress related to nightmares. He wakes up sweaty, the “bed’s a mess,” and he is unable to return to sleep afterwards, which causes him 5-6 hours of sleep loss. Brian indicates that he has these nightmares three times a week. Although the intensity is in the “extreme” range, the frequency is in the “pronounced” range. Therefore, we give him a severity score of “3: Severe/markedly elevated.”

The correct choices are shown to the right.