Part 2 PLEASE DO NOT CONTINUE UNTIL YOU HAVE READ ALL OF PART 1 Self-Assessment Questionnaire This questionnaire will help you determine whether or not you suffer from post- traumatic stress disorder or PTSD. The questions in it are based on the official definition of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the handbook used by all mental health professionals. As you answer these questions, be sure to write down your responses so that you can go over them with your counselor/doctor, if needed. The first set of questions asks you to identify all the traumatic experiences you have had that you can remember. You can be as brief or as detailed as you want in answering the questions. Keep in mind that answering just no is enough. In some cases your reply might be "Maybe" or "I'm not sure". If, and only if, you want to and feel you can emotionally handle it, you may write specific and detailed descriptions. You may also stop writing these descriptions at any point. You should definitely stop if you begin to experience any of the warning signs listed on the warning signs page. Answering these questions may bring up memories you would rather forget. It may also give rise to pain, anger, sadness, or remorse. However, your pur- pose for being in this research is to better understand what happened and how what happened has affected your life. This understanding will enable you to in- crease your control over your present and future life experiences. Questions for Criterion A According to DSM-lV, you must have experienced a traumatic event or series of events in order to qualify as having PTSD. And, either initially or later on, you must have responded to those events with intense fear, helplessness, or horror. In your life, you may have experienced several frightening, sad, or un- happy events, and many major losses. However, only certain events can be categorized as traumatic. By answering the following questions, you can deter- mine whether or not you have been traumatized. If you don't understand what some of the words mean, are unclear whether some of your life experiences "count" as answers, or if you are afraid to answer any of the questions honestly or completely, stop working on these questions.. 1. Have you ever been in a natural catastrophe, such as an earthquake, fire, flood, hurricane, tornado, volcano, landslide, or a dangerous duststorm or windstorm? Have you experienced a community or work-reated disaster, such as an explosion or chemical spill? 2. Have you ever lived in a refugee or concentration camp or been tortured? 3. Were you ever sexually or physically assaulted, either by a stranger, a group of strangers, a family member, or anyone else? Sexual assault includes fondling and molestation; oral, anal, or vaginal sex; and any other forced sexual activity. Physical assault includes any form of activity intended to intimidate or cause pain. Being hit, slapped, thrown down stairs, beaten with fists or objects, or being threatened with a weapon are all considered forms of assault. 4. As a child, were you physically maltreated with excessive beatings or spankings? Were a parent's or caretaker's disciplinary measures sadistic? For example, were you ever forced to eat worms or insects, to stand nude in the cold or in front of others, or to injure a pet, sibling, or another person? Were you ever confined in a cage, a closet, or tied up? Were you ever comfined by lack of access or as a direct result of disabilities. Were you deprived of adequate nutrition and/or medical care? 5 . Have you ever witnessed the death, torture, rape, or beating of another person as part of war or crime? Have you ever seen someone die or be badly injured in a car, airplane, or other such accident? 6. Has anyone in your family or a close friend been murdered? 7. As a child, did you ever witness the beating, rape, murder. torture, or suicide of a parent, caretaker, or friend? 8. Have you ever been in a war, either as a combatant, a medic, a prisoner of war, or a member of a support team or grave registration unit? Were you ever, in any way, exposed to combat, enemy or friendly fire, or atrocities? 9. Have you ever been kidnapped, abducted, raped, burglarized, robbed, or mugged? 10. Were you ever injured in a burglary, robbery, mugging, or other criminal episode or in a car, boat, bicycle, airplane, or other vehicular accident? 11. Have you ever been involved in a situation in which you felt that you or a member of your family would be harmed or killed? Even if your life or the lives of your family members were not directly threatened, did you distinctly fear that you or they were in serious danger? It does not matter if, in retrospect, you realize your fears were unfounded. Neither does it matter if, later on, you decided you were overreacting or foolish for your fears. The critical issue is whether at the time of the trauma you perceived the situation as life-threatening to yourself or others. 12. Were you ever a member of a medical team, a firefighting team, a police force, a rescue squad, or a rescue operation that involved at least one of the following conditions: 0 danger to your safety and life 0 witnessing death and injury 0 making life-and-death decisions 0 high-stress working conditions (long hours, unsafe conditions) If the answer to any one of these questions is yes, then you have experi- enced trauma. However, in order to meet the DSM-IV criteria, in addition to not having witnessed or been directly involved in a traumatic event or series of events, you must have responded to the situation with intense fear, feelings of helplessness, or horror. If these events occurred when you were a child, you might have begun to behave in a disorganized or agitated manner. if you were involved in a trauma and also responded with the feelings listed above, then You have met the first criterion for PTSD. This doesn't mean you necessarily have PTSD. However, it does place you at high risk for suffering from or de- veloping PTSD or some symptoms of PTSD. In order to have PTSD, you also Must meet four other criteria: You must reexperience the trauma, show evidence of numbing or other avoidance behav- ior, and exhibit signs of hyperarousal. In addition, your response to these events must have been so distressing, or your PTSD symptoms so frequent or severe, that your ability to function at home. at work, with friends, or in other areas of life has been damaged. Questions for Criterion B According to the official definition of PTSD in DSM-IV you must be able to answer yes to at least one of the following questions. Write about the ways you reexperience the trauma, again, trying to be as specific as possible. Include information on frequency, duration, and so on. Also, as closely as possible, note the date you first began to reexperience the trauma. 1. Do you, on a persistent or recurring basis, find yourself having intrusive or involuntary thoughts of the traumatic event? Do you find yourself thinking about the trauma when you don't mean to or when you are trying hard not to think about it? Do visions or pictures of the trauma pop into your mind? 2. Do you have dreams or nightmares about the event? 3. Do you have dreams or nightmares that are not replays of the actual event but that take place in the location where the event occurred, contain some of the actions involved in the event, or include some of the feelings you felt during the event? For instance, if you were raped in a parking lot, you may dream about the parking lot without any vision of the rape. Or you may dream about being attacked in some other way or about drowning, suffocating, falling into a well, or watching your house catch on fire. These are not rape dreams, but they capture the feelings of helplessness, fear, anger, and anxiety you most likely experienced during the rape. PTSD-related dreams also include those about a life-threatening event happening to a member of your family or someone you love. 4. Do you find yourself suddenly acting or feeling as if you were back in the original trauma situation? For example, do you have flashbacks, visions, or hear sounds of the event? Do you have waves of strong feelings about the trauma or otherwise feel as if you have just lived through the trauma again, even without having a flashback or a vision? 5. Do you become extremely upset (angry, teary, confused, frightened, anxious, or panicky) around people, places, or events that resemble an aspect of the original trauma? 6. Do you become distressed around the anniversary date of the trauma? 7. Do you have physical reactions when exposed to events that are similar to or symbolize the traumatic event? Such physical reactions include hyperventilation, sweating, vomiting, dizziness, muscle or stomach cramping, shaking, or physical pain not related to any medical condition. For example, someone raped in a green car might feel faint when she sees a green car. A medical staff person who served in a combat zone might start sweating when he sees pictures of wounded soldiers or articles on treating war casualties. If the traumatic event occurred in May, you might start having stomach cramps around that time of the year. How many of the above questions were you able to write about? if You had an affirmative response to at least one of these questions, then you have met the reexperiencing criterion for PTSD. However, even if you answered no to all of these questions, continue on with the rest of the questions. Quite possibly, you do not suffer from full-blown PTSD but from some PTSD symptoms, and even they require healing. Questions for Criterion C The following questions concern psychic numbing and avoidance behavior. Answer yes to the following questions only if the symptoms described presented themselves after the traumatic event (and make a note of the date they began). if you practiced any of the numbing or avoidance behaviors listed below prior e traumatic event, that behavior is not a symptom of PTSD. Describe your yes answers in detail. 1. Since the traumatic event, have you ever had periods of time when felt emotionally numb or dead inside? Have you ever had periods of time when you have had great difficulty feeling tender, loving feelings or any feelings at all except perhaps anger, resentment, or hatred? 2. Have you tried not to talk about the event or avoided thoughts or feelings associated with it? 3. Since the traumatic event, have you felt alienated and apart from others? 4. Have you had a sense of doom or foreboding since the event? Do you feel that you will die young or never experience the rewards of living? For example, do you feel you will never have a family, a career, the love of others, financial security, and so on? 5. Have you lost interest in activities that used to involve you or give you pleasure? These might include sports, hobbies, and other recreational activities; participation in a group; activities involving socializing with others; and eating, dancing, sex, and other activities. 6. Are you unable to remember certain aspects of the trauma? For example, do you have difficulty remembering when it began or how long it lasted? Are there certain details or entire episodes you can't recall? Are there hours, days, weeks, months, or years you can't remember at all? Do you have difficulty remembering the names, faces, or fates of any of the other people involved in the trauma? To how many of these questions did you answer yes? If you have answered yes to at least three of them you have met criterion C for PTSD. Remember, only those avoidance or numbing symptoms that appeared after the traumatic event count. If you had one of these symptoms prior to the traumatic event, you cannot include it as a yes response. Even if you answered yes to less than three of the above questions, continue with the following questions. It may well be that even if you don't suffer from full-blown PTSD, you have troublesome symptoms that need attention. Questions for Criterion D According to DSM-IV, PTSD sufferers must have at least two of the following symptoms of increased arousal: 0 Difficulty falling or staying asleep 0 Irritability or outbursts of anger 0 Difficulty concentrating 0 Hypervigilance or overprotectiveness towards oneself and others 0 Exaggerated startle response (jumping or otherwise overreacting to noises or the sudden appearance of a person) Answer yes to the following questions only if you experience the symptoms relatively frequently and you came to experience these symptoms persistently after, not before, the traumatic event. Record and describe any yes answers in writing along with the approximate date you first experienced the symptom. 1. Do you have difficulty failing or staying asleep? Is your sleep fitful or disturbed in any other way? Insomnia may be a particular problem for you if you were traumatized or abused while in bed, reclining, or asleep. Due to your experience, an association has been made in your mind between being asleep or lying down and being in danger. Therefore, you may feel you have to be on alert at bedtime. Insomnia tends to be a special problem for war veterans, incest survivors, crime victims, and anyone else who has been physically or sexually attacked while sleeping. 2. Do you suffer from periods of irritability that are not directly associated with any present stress or problem in your life? Do you feel tense much of the time? Does your high tension level ever lead to outbursts of anger, such as smashing dishes, punching holes in the wall, throwing objects around the house, yelling at other drivers, or shouting at family members, friends, or coworkers? Do you frequently have to restrain yourself from lashing out at others? 3. Do you have difficulty concentrating? Can You concentrate enough to read an entire magazine article or book, or can you read only a few paragraphs or pages at a time? Are you easily distracted when trying to complete a job or listen to someone talk? 4. Are you overprotective or in Psychological terms, hypervigilant? Are you extremely concerned with your safety and the safety of your loved ones? For example, when you enter a room, do you stand by the door or some other exit for a while in order to scan the room for potential danger? Do you examine people to see if they might be carrying a weapon or be dangerous in some other way? Do you identify places where it would be safe to hide in case of trouble? Whether with others or alone in your home, do you situate yourself so that you can keep frequent surveillance over your environment or make a quick escape in case of danger? Do you carry or sleep with a weapon? Do you try to restrict the comings and goings of people you care about, for fear they will be injured? Do you have an "anxiety attack" if a family member is late coming home? Do you insist that family members and friends call you when they arrive at their destination or if they plan to be even five or ten minutes late? Do crowds make you anxious? Do you avoid shopping malls, parades, movie theaters, concerts, circuses, or large parties? Do you avoid situations where it is difficult to control your level of safety? Do you drive in an excessively cautious manner, even by the most conservative standards? Do you double- or triple-check seatbelts before setting out? 5. Are you easily startled? Do you jump at loud or sudden noises or at noises that resemble some aspect of the trauma? For example, if you are a combat veteran, do you dive to the floor if you hear an airplane overhead? Do you jump if someone touches you from behind or wakes you from your sleep? If you were a victim of a crime committed by an intruder in your home, do you jump when someone unexpectedly comes into the room? To how many questions did you answer yes? If you have answered yes to at least two of the above questions, and the symptom did not exist before the trauma, then you have met the hyperarousal criteria for full-blown PTSD. Whether or not you have met the hyperarousal requirement, continue on to the next sections to determine the severity of your PTSD symptoms. Question for Criterion E Have the symptoms you identified above persisted for more than a month? If so, you meet Criterion E. Questions for Criterion F All PTSD cases are not the same. PTSD symptoms take different forms in different people, depending on their personality, their spiritual or religious beliefs, their culture, and the meaning they ascribe to trauma. You can have PTSD symptoms without having them take over your entire life. The crucial question in assessing the severity of your symptoms and whether you meet criterion F for having PTSD is, "How much do they affect your ability to work, love, and play?" Criterion F states that to be diagnosed as having PTSD, your symptoms must cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning." If you have met Criteria A, B, C, and D for PTSD, it is likely that your symptoms cause you considerable difficulties at times. However, if in general, you feel satisfied with life and are able to hold down a job and have fulfilling relationships with other people, you will probably not be considered to have PTSD as defined by the DSM-IV. Even if your symptoms sometimes become worse in situations or times of stress, so long as you "bounce-back" and there are no long-term aftereffects, then you will most likely not be diagnosed as having PTSD. Symptoms that could cause social and vocational problems include: Difficulty concentrating Anxiety and panic attacks Memory loss (short-term or long-term) Flashbacks and intrusive thoughts Insomnia and other sleep problems Overwhelming feelings of anger or sorrow "Freezing" -- being unable to move, speak, or interact Withdrawal Depression Your answers to the following questions will give you and us an idea of the degree to which your symptoms affect your present life functioning. It is very important that you record the details of any "yes" answers. For exam- ple, if your symptoms cause you to withdraw from people, describe the situ- ations in which you withdraw and how frequently those situations occur. 1. Do your PTSD symptoms affect your ability to work and, if so, to what degree? For example, are you unable to complete tasks on time? Does an inability to communicate with or relate to coworkers or others make it difficult or impossible to perform effectively? Do your symptoms indanger yourself or others because of the nature of your work? Does work itself worsen your symptoms to such a degree that you must leave the job? 2. Do your PTSD symptoms make it difficult or impossible to maintain friendships or relationships with family members or intimate others? For example, have your symptoms significantly contributed to a divorce or estrangement from those you had been close to? Have your symptoms or your fears about how others might react to your symptoms caused you to sever old ties or avoid new relationships? 3. Have your symptoms affected you to such a degree that, in addition to preventing you from holding a job and having fulfilling relationships, you are unable to take care of your basic living needs, such as health care, personal hygiene, proper diet, paying bills, using the telephone? 4. As a result of anger, anxiety, depression, or other symptoms, do you stay at home whenever possible and avoid contact with other people? Do you have thoughts of suicide or homicide so that you feel you a real danger to yourself or others? If you have met Criteria A, B, C, D, and E, and you feel these symptoms have had a significant adverse effect on your life, you will likely be diagnosed as suffering from PTSD. If you have met some but not all of the criteria, it is likely that you are suffering the aftereffects of trauma and have PTSD symptoms that would benefit from treatment. In either case, the ultimate decision about whether you can be diagnosed as having PTSD will probably be made by your counselor/doctor, perhaps in conjuction with other mental health workers. Based on the results of the above questionaire, do you feel you have PTSD? _________________________________________. THANK YOU FOR YOUR EFFORTS AND COOPERATION. ( Email to Dr. Clyde Shideler at cedisabl@sprynet.com )