[form] PTSD Presence Indicators Your Name please: [text,r_name,30] Email: [text,r_email,30] Symptoms of PTSD CHECK any box that is true of your present experience of functioning 1. You have been exposed to a traumatic event in which both of the following were present: [checkbox,1SPTSD01] ___You experienced, or witnessed, or were confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of yourself or others. [checkbox,1SPTSD02] ___Your response involved intense fear, helplessness, or horror, or your perception of the event led to these emotions. 2. You re-experience the event in one or more of the following ways [checkbox,2SPTSD03] ___You have recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. [checkbox,2SPTSD04] ___You have recurrent distressing dreams of the event. [checkbox,2SPTSD05] ___You act or feel as if the traumatic event was recurring, and you may have a sense of reliving the experience through illusions, hallucinations, and active flashbacks. [checkbox,2SPTSD06] ___You experience intense psychological distress or bodily reactions when exposed to internal or external cues that symbolize or resemble an aspect of the traumatic event (e.g. sights, smells, sounds, dates); these are called triggers. 3. You persistently avoid things or events (triggers) associated with the trauma and numb your response using three or more of the following: [checkbox,3SPTSD07] ___You make a great effort to avoid thoughts, feelings or conversations associated with the trauma, or to avoid activities, places, or people that would cause you to remember the trauma. [checkbox,3SPTSD08] ___You can't recall an important aspect of the trauma. [checkbox,3SPTSD09] ___Your interest or participation in activities is much less. [checkbox,3SPTSD10] ___You feel detached or estranged from others. [checkbox,3SPTSD11] ___Your ability to feel emotion is restricted, as is your range of emotions (e.g. you are unable to have loving feelings). [checkbox,3SPTSD12] ___You have a sense of a foreshortened future - you can't see ahead into a far-off future (e.g. you do not expect to have a career, marriage, children, or a normal life span). 4. You also have persistent symptoms of increased physical arousal that were not present before the trauma, as indicated by two or more of the following. You experience: [checkbox,4SPTSD13] ___Difficulty falling or staying asleep [checkbox,4SPTSD14] ___Irritability or outbursts of anger [checkbox,4SPTSD15] ___Difficulty concentrating [checkbox,4SPTSD16] ___Hyper vigilance (being overly watchful) [checkbox,4SPTSD17] ___Exaggerated startle response (You're jumpy) 5. [checkbox,5SPTSD18] All of these symptoms have lasted more than one month. 6. [checkbox,6SPTSD19] Because of these symptoms, you are significantly distressed or impaired in social, occupational, or other important areas of functioning. NOTE: The PTSD is acute if your symptoms have been there less than three months, and chronic if your symptoms have lasted three months or more. It is delayed onset if your symptoms began at least six months after the stressor event or events. ANY questions or comments? [textarea,questions or comments,3,70] PRINT a copy for your own records [submit,SEND this Entry][reset,Start Over again] [/form]