PTSD Evaluations

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Which of the following best describes your trauma?
Witnessing death or injuryPhysical assault/abuseCombat/military experienceMilitary sexual traumaSexual assault/rapeNatural disaster/fireChildhood sexual abuse/molestationAccident: MVA/boating/motorcycleIncarcerationSudden/traumatic death of a family member/friendFirst ResponderChildhood Physical AbuseChildhood Emotional AbuseChildhood Abandonment/NeglectDysfunctional UpbringingLife Threatening ExperienceChildhood Foster CareVictim of Sex TraffickingVictim of Domestic Violence

Repeated, disturbing, and unwanted memories of the stressful experience?
Not at allA little bitModeratelyQuite a bitExtremely

Nightmares or disturbing dreams?
Not at allA little bitModeratelyQuite a bitExtremely

Flashbacks?
Not at allA little bitModeratelyQuite a bitExtremely

Feeling very upset when something reminded you of the trauma?
Not at allA little bitModeratelyQuite a bitExtremely

Anxiety?
Not at allA little bitModeratelyQuite a bitExtremely

Avoiding memories of the trauma?
Not at allA little bitModeratelyQuite a bitExtremely

Avoiding reminders of the trauma?
Not at allA little bitModeratelyQuite a bitExtremely

Trouble remembering parts of the trauma?
Not at allA little bitModeratelyQuite a bitExtremely

Negative beliefs about yourself, others, or the world?
Not at allA little bitModeratelyQuite a bitExtremely

Blaming yourself or someone else for the trauma?
Not at allA little bitModeratelyQuite a bitExtremely

Fear, horror, anger, guilt or shame?
Not at allA little bitModeratelyQuite a bitExtremely

Loss of interest in activities you used to enjoy?
Not at allA little bitModeratelyQuite a bitExtremely

Feeling detached from others?
Not at allA little bitModeratelyQuite a bitExtremely

Trouble experiencing positive emotions?
Not at allA little bitModeratelyQuite a bitExtremely

Irritable, angry outbursts, or acting aggressively?
Not at allA little bitModeratelyQuite a bitExtremely

Risk-taking?
Not at allA little bitModeratelyQuite a bitExtremely

Being super-alert, watchful, or on-guard?
Not at allA little bitModeratelyQuite a bitExtremely

Easily startled?
Not at allA little bitModeratelyQuite a bitExtremely

Difficulty concentrating?
Not at allA little bitModeratelyQuite a bitExtremely

Trouble falling or staying asleep?
Not at allA little bitModeratelyQuite a bitExtremely

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