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Trauma Survey

1.

Repeated disturbing memories,thoughts,or images of the stressful experience? 

*This question is required.
2.

Repeated, disturbing dreams of the stressful experience? 

*This question is required.
3.

Suddenly acting or feeling as if the stressful experience were happening again (as if you were reliving it)? 

*This question is required.
4.

Feeling very upset when something reminded you of the stressful experience? 

 

*This question is required.
5.

Having physical reactions (e.g.,heartpounding, trouble breathing, or sweating) when something reminded you of the stressful experience? 

 

*This question is required.
6.

Avoiding thinking about or talking about the stressful experience or avoiding having feelings related to it? 

*This question is required.
7.

Avoiding activities or situations because they remind you of the stressful experience? 
8.

Trouble remembering important parts of the stressful experience? 

*This question is required.
9.

Loss of interest in activities that you used to enjoy? 

*This question is required.
10.

Feeling distant or cutoff from other people? 

*This question is required.
11.

Feeling emotionally numb or being unable to have loving feelings for those close to you? 

*This question is required.
12.

Feeling as if your future will somehow be cut short? 

*This question is required.
13.

Trouble falling or staying asleep? 

*This question is required.
14.

Feeling irritable or having angry outbursts? 

*This question is required.
15.

Having difficulty concentrating? 

*This question is required.
16.

Being “super alert” or watchful or on guard? 

*This question is required.
17.

Feeling jumpy or easily startled? 

*This question is required.
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