Screening for PTSD

If you suspect that you might suffer from PTSD, answer the questions below honestly with Yes or No responses, record the results and share them with your health care professional. you can also download this survey as a Word Document here.

You have experienced or witnessed a life threatening event to you or your loved ones that caused intense fear, helplessness or horror

Do you re-experience the event in at least one of the following ways?

Repeated, distressing memories or dreams
Acting or feeling as if the event were happening again (flashbacks)
Intense physical and/or emotional distress when you are exposed to things that remind you of the event

Do reminders of the event affect you in at least three of the following ways?

Avoiding thoughts, feelings or conversations about it
Avoiding activities and places or people who remind you of it
Blanking on important parts of it
Losing interest in significant activities of your life
Feeling detached from other people
Feeling your range of emotions is restricted
Sensing that your future has shrunk (for example, you don’t expect to have a career, marriage, children or normal life span)

Are you troubled by at least two of the following?

Problems sleeping
Irritability or outbursts of anger
Problems concentrating
Feeling “on guard”
An exaggerated startle response

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Depression and substance abuse are among the conditions that occasionally complicate PTSD and other anxiety disorders.

Have you experienced changes in sleeping or eating habits?

More days than not, do you feel…..

sad or depressed?
disinterested in life?
worthless or guilty?

During the last year, has the use of alcohol or drugs…

resulted in your failure to fulfill responsibilities with work, school or family?
placed you in a dangerous situation, such as driving a car under the influence?
gotten you arrested?
continued despite causing problems for you or your loved ones?