904-737-3232 (P)
866-631-9482 (F)
Email: admin@rivershorescounseling.com
Website: www.rivershorescounseling.com

Below is a list of problems that people sometimes have after experiencing a traumatic event. Please answer YES or NO to each item, even if you believe the symptom is mild. If you answer YES to three of more of these questions, you should be assessed to get help for PTSD and related mental health issues.
1.	Having upsetting thoughts or images about the traumatic event that come into
your head when you did not want them to	Y  	N	
2.	Having had bad dreams or nightmares about the traumatic event	Y	N	
3.	Reliving the traumatic event (acting as if it were happening again	Y	N	
4.	Feeling emotionally upset when you are reminded of the traumatic event	Y	N	
5.	Experiencing physical reactions when reminded of the traumatic event (sweating, increased heart rate, physical pain)	Y	N	
6.	Trying not to think or talk about the traumatic event	Y	N	
7.	Fixated on the traumatic event, can’t stop replaying the event in your head			
8.	Trying to avoid activities or people that remind you of the traumatic event	Y	N	
9.	Not being able to remember an important part of the traumatic event	Y	N	
10.	Having much less interest or participating much less often in important activities	Y	N	
11.	Feeling distant of cut off from the people around you	Y	N	
12.	Feeling emotionally numb (unable to cry or have loving feelings)	Y	N	
13.	Feeling as if your future hopes or plans will not come true.	Y	N	
14.	Having trouble falling asleep or staying asleep.	Y	N	
15.	Feeling irritable or having fits of anger	Y	N	
16.	Having trouble concentrating	Y	N	
17.	Being overly alert	Y	N	
18.	Being jumpy or easily startled	Y	N	
19.	Suicidal thoughts or feelings	Y	N	
20.	Neglect of personal care, hygiene, nutrition, exercise	Y	N	
21.	Self-isolating, dread of social interaction	Y	N	
22.	Anxiety in crowds, traffic	Y	N	
23.	Inability to trust others	Y	N	
24.	Using drugs, alcohol and/or food to “numb” yourself	Y	N	
25.	Physical/emotional reaction to things that remind you of the event.	Y	N	
26.	Problems with friendships, family relationships, sex life	Y	N