PTSD Screening Tool

Instructions: A person who has had an extremely stressful experience may have many a range of different problems as a result of the stressful experience. Some people have had more than one extremely stressful experience. For each of the questions
below, keep your worst experience or event in mind. Please read each problem carefully and then select one response to indicate how much you have been bothered by that problem in the past month.

Please note, this screening does not serve as a diagnosis tool but can aid your clinician in determining our recommended course of action.

In the past month, how much were you bothered by:

1. Repeated, disturbing, and unwanted memories of the stressful experience? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

2. Repeated, disturbing dreams of the stressful experience? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

4. Feeling very upset when something reminded you of the stressful experience? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

6. Avoiding memories, thoughts, or feelings related to the stressful experience? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

8. Trouble remembering important parts of the stressful experience? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

9. 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)? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

10. Blaming yourself or someone else for the stressful experience or what happened after it? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

12. Loss of interest in activities that you used to enjoy? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

13. Feeling distant or cut off from other people? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

15. Irritable behavior, angry outbursts, or acting aggressively? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

16. Taking too many risks or doing things that could cause you harm? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

17. Being “superalert” or watchful or on guard? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

18. Feeling jumpy or easily startled? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

19. Having difficulty concentrating? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

20. Trouble falling or staying asleep? *0. Not at all1. A little bit2. Moderately3. Quite a bit4. Extremely

First Name *

Last Name *

Your Email *

Select Your State *

Electronic Communication Consent

Providing us with authorization to email and text you will allow Kentuckiana Integrative Medicine - Kentuckiana Medicine to exchange information with you more efficiently and will benefit you as a member patient. We have made considerable effort to protect the personal health information of our member patients. The messages we will send are focused on promoting good health and education.

Yes, you can communicate with me via email. Subscribe me to the newsletter.

Yes, you can communicate with me via text message.

Security Question (10-5=?) *

Follow us on Facebook for Weekly Medical Insights

About Us

405 E Court Ave #102, Jeffersonville, IN 47130

(812) 913-4416

Latest Posts

Why Choose Kentuckiana Integrative Medicine-Kentuckiana Ketamine Institute?
Teen Suicide Prevention
Can You Recognize the Signs of Depression?
Mental Health Challenges, Pain, and Ketamine

Disclaimer

This article is strictly informational. We make no implied or explicit claims of treatment effectiveness or suitability. Those decisions are between you and your physician.
Like all medical procedures, our procedures have a success and failure rate. Patient testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments.

Medical Disclaimer
Terms and Conditions
Privacy Policy
Accessibility Statement