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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

Reference:

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 information@adaa.org.

Learn more about PTSD and its impact at BetterHelp.com.