PTSD Form Repeated, disturbing, and unwanted memories of the stressful experience?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Repeated, disturbing dreams of the stressful experience?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Feeling very upset when something reminded you of the stressful experience?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Avoiding memories, thoughts, or feelings related to the stressful experience?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Trouble remembering important parts of the stressful experience?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
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)?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Blaming yourself or someone else for the stressful experience or what happened after it?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Loss of interest in activities that you used to enjoy?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Feeling distant or cut off from other people?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Irritable behaviour, angry outbursts, or acting aggressively?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Taking too many risks or doing things that could cause you harm?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Being "superalert" or watchful or on guard?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Feeling jumpy or easily startled?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Having difficulty concentrating?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
Trouble falling or staying asleep?
- Select - Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
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