PTSD Symptom Severity Assessment Questionnaire Form
Please rate the severity of your PTSD symptoms over the past month. Answer each question as accurately as possible. Your responses are confidential and used only for assessment purposes.
Re-experiencing Distressing Memories
*
1
2
3
4
5
Nightmares or Disturbing Dreams
*
1
2
3
4
5
Sudden Emotional or Physical Reactions to Reminders
*
1
2
3
4
5
Avoiding Thoughts, Feelings, or Conversations About the Trauma
*
1
2
3
4
5
Avoiding Activities, Places, or People That Remind You of the Trauma
*
1
2
3
4
5
Negative Beliefs About Yourself, Others, or the World
*
1
2
3
4
5
Persistent Negative Emotional State (e.g., fear, anger, guilt, shame)
*
1
2
3
4
5
Feeling Distant or Cut Off from Others
*
1
2
3
4
5
Difficulty Sleeping or Staying Asleep
*
1
2
3
4
5
Irritability, Angry Outbursts, or Difficulty Concentrating
*
1
2
3
4
5
Submit Assessment
Should be Empty: