9a Mathematics Expert Only no Others
malibumark21
ExampleSurveyQuestionsPTSD.docxExample Survey Questions PTSD
https://www.ptsd.va.gov/professional/assessment/screens/pc-ptsd.asp
Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:
· a serious accident or fire
· a physical or sexual assault or abuse
· an earthquake or flood
· a war
· seeing someone be killed or seriously injured
· having a loved one die through homicide or suicide.
Have you ever experienced this kind of event? YES / NO
If no, screen total = 0. Please stop here.
If yes, please answer the questions below.
In the past month, have you...
1. Had nightmares about the event(s) or thought about the event(s) when you did not want to? YES / NO
2. Tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? YES / NO
3. Been constantly on guard, watchful, or easily startled? YES / NO
4. Felt numb or detached from people, activities, or your surroundings? YES / NO
5. Felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? YES / NO
Citation
Prins, A., Bovin, M. J., Kimerling, R., Kaloupek, D. G., Marx, B. P., Pless Kaiser, A., & Schnurr, P. P. (2015). The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). [Measurement instrument].
https://adaa.org/screening-posttraumatic-stress-disorder-ptsd
|
Yes No |
You have experienced or witnessed a life-threatening event that caused intense fear, helplessness, or horror. |
Do you have intrusions about the event in at least one of the following ways?
|
Yes No |
Repeated, distressing memories, or dreams |
|
Yes No |
Acting or feeling as if the event were happening again (flashbacks or a sense of reliving it) |
|
Yes No |
Intense physical and/or emotional distress when you are exposed to things that remind you of the event |
Do you avoid things that remind you of the event in at least one of the following ways?
|
Yes No |
Avoiding thoughts, feelings, or conversations about it |
|
Yes No |
Avoiding activities and places or people who remind you of it |
Since the event, do you have negative thoughts and mood associated with the event in at least 2 of the following ways?
|
Yes No |
Blanking on important parts of it |
|
Yes No |
Negative beliefs about oneself, others and the world and about the cause or consequences of the event |
|
Yes No |
Feeling detached from other people |
|
Yes No |
Inability to feel positive emotions |
|
Yes No |
Persistent negative emotional state |
Are you troubled by at least two of the following?
|
Yes No |
Problems sleeping |
|
Yes No |
Irritability or outbursts of anger |
|
Yes No |
Reckless or self-destructive behavior |
|
Yes No |
Problems concentrating |
|
Yes No |
Feeling "on guard" |
|
Yes No |
An exaggerated startle response |
Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
https://psychcentral.com/quizzes/ptsd-quiz/
1. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?
Never Rarely Sometimes Often Very Often
2. Feeling very upset when something reminded you of a stressful experience from the past?
Never Rarely Sometimes Often Very Often
3. Avoid activities or situations because they remind you of a stressful experience from the past?
Never Rarely Sometimes Often Very Often
4. Feeling distant or cut off from other people?
Never Rarely Sometimes Often Very Often
5. Feeling irritable or having angry outbursts?
Never Rarely Sometimes Often Very Often
6. Having difficulty concentrating?
Never Rarely Sometimes Often Very Often
