Trauma Symptom Checklist: Where to Begin

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If you have been through a traumatic event, you may find it hard to talk about your experiences. But, it can be helpful to tell your doctor or a counselor about any symptoms you have. Witnessing or going through a trauma can lead to both emotional and physical problems.

The checklist below can be a good start to talking about your symptoms following a trauma. You can print this page, complete the checklist and show it to your doctor, therapist, or someone who can help you find care.

Sharing this information will help a health care provider know you better and plan the best treatment for you. Not everyone who goes through trauma will get PTSD, but keep in mind that good treatments are available even if you only have some PTSD symptoms.

POST TRAUMATIC STRESS DISORDER

We usually recognize these as things like, natural disasters, terrorist incidents, serious accidents, military combat, or violent personal assaults like rape. A traumatic experience can be any experience involving the threat of death or serious injury to an individual or another person close to them. For some women, it is not always obvious dramatic events that trigger childbirth trauma. Other factors such as loss of control, may be highly traumatic for them, (particularly if they have had certain negative experiences in the the past.)

It is normal for people to experience some or all of the symptoms described below following a traumatic event. These symptoms often resolve themselves after a month or so. However, if you continue to experience these symptoms then psychiatrists call this post traumatic stress disorder and you may need some help to relieve the symptoms.

SYMPTOMS OF PTSD
The things people with PTSD may experience include:
~Intense fear, helplessness or horror about their experience.
~Re-experiencing of the event with intrusive memories, flashbacks and nightmares.
~Feeling distressed, anxious or panicky when exposed to things which remind them of the event.
~Avoidance of anything that reminds them of the trauma.
~Bad memories and tension will often result in difficulties with sleeping and concentrating.
~Sufferers may also feel angry, irritable and be hypervigilant (feel jumpy or on their guard all the time).

It is important to remember that the above symptoms are a normal response to a traumatic experience. The re-experiencing of the event with flashbacks accompanied by genuine anxiety and fear are the mind's way of trying to make sense of an extremely scary experience. They are not a sign individual 'weakness' or inability to cope. Over time these feelings will usually settle but if not then can result in problems.

COMPLEX PTSD

Complex PTSD (sometimes called "Disorder of Extreme Stress") is found among people who have been exposed to prolonged traumatic circumstances or several traumatic events occurring at different times, especially during childhood, such as childhood sexual abuse.

Developmental research is revealing that many brain and hormonal changes may occur as a result of early, prolonged trauma, and can contribute to many long term behavioural and emotional difficulties including; impulsivity, aggression, sexual acting out, eating disorders, alcohol/drug abuse, self destructive actions, intense rage, depression, panic, dissociation (blanking out), and amnesia.

Some people may experience only mild difficulties, while other people may have severe difficulties involving many of the above issues. The extent of someone’s difficulties will depend on many factors such as the nature and duration of the trauma as well as the person’s other life experiences.

Please Answer The Following Questions

The event happened on (day/month/year): *

What happened? *

BRIEF CHECK LIST OF SYMPTOMS BELOW

Check the symptoms below that you experience. Include symptoms you have even if you are not sure they are related to a traumatic event.

I experienced or witnessed a traumatic event during which I felt extreme fear, helplessness, or horror.

I have symptoms of re-experiencing or reliving the traumatic event: *

Have bad dreams or nightmares about the event or something similar to it

Behave or feel as if the event were happening all over again (this is known as having flashbacks)

Have a lot of strong or intense feelings when I am reminded of the event

Have a lot of physical sensations when I am reminded of the event (for example, my heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I'm going to lose control)

Other:

Required

I have symptoms of avoiding reminders of the traumatic event: *

Avoid thoughts, feelings, or talking about things that remind me of the event

Avoid people, places, or activities that remind me of the event

Have trouble remembering some important part of the event

Other:

Required

I have noticed these symptoms since the event happened: *

Have lost interest in, or just don't do, things that used to be important to me

Feel detached from people; find it hard to trust people

Feel emotionally "numb" or find it hard to have loving feelings even toward those who are emotionally close to me

Have a hard time falling or staying asleep

Am irritable and have problems with my anger

Have a hard time focusing or concentrating

Think I may not live very long and feel there's no point in planning for the future

Am jumpy and get startled or surprised easily

Am always "on guard"

Other:

Required

I experience these medical or emotional problems: *

Stomach problems

Intestinal (bowel) problems

Gynecological (female) problems

Weight gain or loss

Pain, for example, in back, neck, or pelvic area

Headaches

Skin rashes and other skin problems

Lack of energy; feel tired all the time

Alcohol, drug, or other substance use problems

Depression or feeling down

Anxiety or worry

Panic attacks

Other symptoms such as:

Other:

Required

FIRST & LAST NAME *

CONTACT BY *

Contact Information *

Please provide email address and/or cell/phone number for your own reference.

SUMMING IT UP:

If you checked off some of the symptoms above, it is important for you to let your health care provider know. This information helps providers plan your medical treatment. It can also help them connect you with services you may need.

If you think you may have PTSD, print this checklist, fill it out, and take it to a health care provider, or someone you trust.
http://www.ptsd.va.gov/public/pages/trauma-symptom-checklist.asp

WHERE TO GET HELP:

United States Department of Veterans Affairs
PTSD Help Page Link: http://www.ptsd.va.gov/public/where-to-get-help.asp
~Call 911
~Go to the nearest Emergency Room
~Call the Suicide Prevention Lifeline 1-800-273-8255
~Contact the Veterans Crisis Line: 1-800-273-8255, press 1 (text 838255) or Confidential Veterans Chat with a counselor
Please note that the National Center for PTSD does not provide direct clinical care or individual referrals. We provide information to help you find local mental health services and information on trauma and PTSD.

PTSD Care for Everyone:
1. Finding a Therapist - http://www.ptsd.va.gov/public/pages/finding-a-therapist.asp
Information, phone numbers and websites to help locate care for PTSD.
2. Help for Family and Friends - http://www.ptsd.va.gov/public/pages/resources_family_friends.asp
Learn about resources to help you take care of yourself while supporting someone with PTSD.

PTSD Care for Veterans, Military, and Families:
All VA Medical Centers provide PTSD care, as well as many VA clinics - http://www.va.gov/directory/guide/home.asp

Information on website (http://www.ptsd.va.gov) is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.

For Your Information Only

This form is provided for educational information only. Completing this form and printing it out will make it a little simpler to review with your person of choice. I wish you the best of luck and well wishes for a speedy recovery to any one of the symptoms noted.

PLEASE DO NOT CLICK THE SUBMIT BUTTON BELOW. PRINT AND/OR SAVE FOR YOUR OWN REFERENCE.

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