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Self Assessment for Post Traumatic Stress Disorder

Please indicate how you felt for the past 4 weeks, over all, by circling the number that best reflects the severity and intensity of the following symptoms. If you are not sure, please choose just one number, between 1-10, 1 being the least and 10 the most severe and intense. Please be as accurate as possible.
  A. You persistently experience the traumatic event in the following ways:

1. Experiencing intrusive, distressing recollections of the traumatic event, including:
images, thoughts, or perceptions.
2. Experiencing recurrent distressing dreams of the traumatic event.
3. Acting or feeling as if the traumatic event were recurring, including a sense of reliv-
ing the experience, illusions, hallucinations, and flashback episodes, including those
that occur when awakening or when intoxicated.
4. Experiencing intense psychological distress at exposure to internal or external cues
that symbolize or resemble an aspect of the traumatic event.
5. Experiencing intense psychological reactivity (symptoms) on exposure to internal or
external cues that symbolize or resemble an aspect of the traumatic event.
  B. You persistently avoid stimuli associated with the traumatic event and attempt to numb general reactions (not present before the trauma) as indicated by the following:

1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
2. Efforts to avoid activities, places, or people that arouse recollections of the trauma.
3. Inability to recall an important aspect of the trauma.
4. Markedly diminished interest or participation in significant activities.
5. Feelings of detachment or estrangement from others.
6. Restricted range of affect (feelings) e.g. unable to have loving feelings.
7. Experience a psychological reactivity (symptoms) sense of a foreshortened future
(doom and gloom) e.g. no expectations to have a career, marriage, children, or a
normal life span.
  C. You experience an increased arousal in the persistent symptoms (not present before
the trauma), as indicated by the following:

1. Difficulty falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulty concentrating.
4. Hypervigilance.
5. Exaggerated startle response.
Assessment Score:

For more information or to make an appointment, please call 305-251-8609 or email me by Clicking Here

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Dita Teitelbaum, MSW LCSW
14440 SW 80th Avenue
Miami, FL 33158
Phone: 305-251-8609
Fax: 305-251-8609

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