Traumatic Stress Reactions

1. Either experienced, witnessed, or was confronted with an event that involved actual or threatened death, serious injury or threat of death or injury and responded with feelings of fear, helplessness, or horror?
Yes No

Have you persistently experienced:

2. recurrent and intrusive recollections of the event that are distressing?
Yes No

3. recurrent and distressing dreams/nightmares of the event?
Yes No

4. feeling like or acting as if the traumatic event was happening again or having flashbacks or other sensory experiences of reliving the event?
Yes No

5. feeling very distressed when you experience internal or external cues that remind you of the traumatic event?
Yes No

6. having a physical response (i.e., increased heart rate, nausea, etc.) when you experience internal or external cues that remind you of the traumatic event?
Yes No

7. avoidance or feelings of numbness around stimuli associated with the traumatic event that may include:

• efforts to avoid thoughts, conversations, or feelings related to the trauma,
• avoidance of activities, places or people who remind you of the trauma,
• forgetting important aspects of the traumatic event,
• having a loss of interest in important activities,
• feeling distant from others,
• having a restricted range or numbness of feelings/emotions,
• a sense that the future is threatened and possibly foreshortened?

Yes No

8. feeling an increased sense of tension/arousal that may be indicated by:

• difficulty falling or staying asleep,
• feeling irritable and/or having outbursts of anger,
• having difficulty concentrating,
• being easily startled
• being hypervigilant (observing the environment so as to constantly notice impending threats)

Yes No