If you suspect that you might suffer from PTSD, answer the questions below, print out the results and share them with your health care professional. You can also download this form here.
To locate a specialist who treats PTSD, visit the ADAA Find a Therapist.
Are you troubled by the following?
|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|
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
Please print this completed form and share it with your health care provider to determine diagnoses. For more information, visit us at www.adaa.org or contact us at firstname.lastname@example.org.