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Body Trauma Score Quiz
Assessing The Impact Of Trauma On The Body
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1
General Sensitivity and Dysregulation
*
This field is required.
0 = not true at all / does not relate to you at all 1 = true to a small degree / having a small but noticeable impact on your daily life 2 = true to a moderate degree / having a moderate impact on your daily life 3 = true to a large degree / having a significant impact
0
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2
3
I frequently feel overwhelm
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I am sensitive to other people’s energy and mood
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I am sensitive to noises and bright lights
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Small things stress me out
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My reactions are often either over-reactive or I freeze inside and don’t know how to respond
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I use coping mechanisms or strategies that come at a cost to self-soothe and escape
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I have trouble sleeping well
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I experience a chronic skin condition that changes with foods or stress (rashes, eczema, acne)
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I always see danger and am on the defensive
Row 8, Column 0
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I frequently feel overwhelm
I am sensitive to other people’s energy and mood
I am sensitive to noises and bright lights
Small things stress me out
My reactions are often either over-reactive or I freeze inside and don’t know how to respond
I use coping mechanisms or strategies that come at a cost to self-soothe and escape
I have trouble sleeping well
I experience a chronic skin condition that changes with foods or stress (rashes, eczema, acne)
I always see danger and am on the defensive
0
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0
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0
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0
Row 5, Column 0
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Row 6, Column 0
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Row 7, Column 0
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2
General Sensitivity and Dysregulation Average Score
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3
General Sensitivity and Dysregulation Total Score
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4
Digestive System
*
This field is required.
0 = not true at all / does not relate to you at all 1 = true to a small degree / having a small but noticeable impact on your daily life 2 = true to a moderate degree / having a moderate impact on your daily life 3 = true to a large degree / having a significant impact
0
1
2
3
I experience abdominal pain that changes with eating, bowel movements or throughout the day
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
I often experience symptoms of constipation and/or diarrhea
Row 1, Column 0
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After eating, I can feel tired, depressed, get a headache or can’t focus
Row 2, Column 0
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I have or have had a diagnosis of bowel disease of IBS, Crohn’s or Ulcerative Colitis
Row 3, Column 0
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Gluten, highly processed foods and non-organic foods are part of my diet
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I am or have been an emotional eater
Row 5, Column 0
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I experience abdominal pain that changes with eating, bowel movements or throughout the day
I often experience symptoms of constipation and/or diarrhea
After eating, I can feel tired, depressed, get a headache or can’t focus
I have or have had a diagnosis of bowel disease of IBS, Crohn’s or Ulcerative Colitis
Gluten, highly processed foods and non-organic foods are part of my diet
I am or have been an emotional eater
0
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0
Row 1, Column 0
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3
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0
Row 2, Column 0
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0
Row 3, Column 0
1
Row 3, Column 1
2
Row 3, Column 2
3
Row 3, Column 3
0
Row 4, Column 0
1
Row 4, Column 1
2
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3
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0
Row 5, Column 0
1
Row 5, Column 1
2
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5
Digestive System Average Score
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6
Digestive System Total Score
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7
Energy, Brain and Neurotransmitters
*
This field is required.
0 = not true at all / does not relate to you at all 1 = true to a small degree / having a small but noticeable impact on your daily life 2 = true to a moderate degree / having a moderate impact on your daily life 3 = true to a large degree / having a significant impact
0
1
2
3
If things take more time than I planned, I get irritated
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
I experience a daily sense of exhaustion
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I reach for things that will give me quick energy to get through my day
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I consider myself an adrenaline junkie or seek excitement to feel alive
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I experience uncontrollable craving for sweets and carbs
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I have a poor active working memory (e.g. forgetfulness in the middle of a task, don’t remember when I just put my keys or my drink)
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Row 5, Column 3
I experience anxiety
Row 6, Column 0
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I experience depression
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Row 7, Column 3
I am on or have been on mood medications
Row 8, Column 0
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I have had a major surgery requiring anesthesia
Row 9, Column 0
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I experience an energy crash after either exercising or after something emotional
Row 10, Column 0
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Row 10, Column 2
Row 10, Column 3
If things take more time than I planned, I get irritated
I experience a daily sense of exhaustion
I reach for things that will give me quick energy to get through my day
I consider myself an adrenaline junkie or seek excitement to feel alive
I experience uncontrollable craving for sweets and carbs
I have a poor active working memory (e.g. forgetfulness in the middle of a task, don’t remember when I just put my keys or my drink)
I experience anxiety
I experience depression
I am on or have been on mood medications
I have had a major surgery requiring anesthesia
I experience an energy crash after either exercising or after something emotional
0
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3
Row 0, Column 3
0
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0
Row 2, Column 0
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0
Row 3, Column 0
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Row 3, Column 1
2
Row 3, Column 2
3
Row 3, Column 3
0
Row 4, Column 0
1
Row 4, Column 1
2
Row 4, Column 2
3
Row 4, Column 3
0
Row 5, Column 0
1
Row 5, Column 1
2
Row 5, Column 2
3
Row 5, Column 3
0
Row 6, Column 0
1
Row 6, Column 1
2
Row 6, Column 2
3
Row 6, Column 3
0
Row 7, Column 0
1
Row 7, Column 1
2
Row 7, Column 2
3
Row 7, Column 3
0
Row 8, Column 0
1
Row 8, Column 1
2
Row 8, Column 2
3
Row 8, Column 3
0
Row 9, Column 0
1
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0
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8
Energy, Brain and Neurotransmitters Average Score
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9
Energy, Brain and Neurotransmitters Total Score
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10
Chronic Conditions
*
This field is required.
0 = not true at all / does not relate to you at all 1 = true to a small degree / having a small but noticeable impact on your daily life 2 = true to a moderate degree / having a moderate impact on your daily life 3 = true to a large degree / having a significant impact
0
1
2
3
I have a chronic health issue (1 for 1 health issue, 3 is 3 or more chronic health issues)
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
I have long-haul symptoms of an infection (mold, lyme, viral infections, etc.)
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
I have an autoimmune condition
Row 2, Column 0
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Row 2, Column 2
Row 2, Column 3
I have a chronic health issue that affects my breathing (bloating, asthma, heart disease, etc.)
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
I am on a number of prescription medications for my chronic health issues
Row 4, Column 0
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Row 4, Column 3
I am underweight, overweight or obese
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
I have thyroid problems (ie. hypothyroidism or hyperthyroidism)
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
I experience depression
Row 7, Column 0
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Row 7, Column 2
Row 7, Column 3
I have hormone imbalances including adrenal fatigue
Row 8, Column 0
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Row 8, Column 2
Row 8, Column 3
I have or have been diagnosed with a cancer
Row 9, Column 0
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Row 9, Column 2
Row 9, Column 3
I have bags under my eyes when I wake up
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
I have a chronic health issue (1 for 1 health issue, 3 is 3 or more chronic health issues)
I have long-haul symptoms of an infection (mold, lyme, viral infections, etc.)
I have an autoimmune condition
I have a chronic health issue that affects my breathing (bloating, asthma, heart disease, etc.)
I am on a number of prescription medications for my chronic health issues
I am underweight, overweight or obese
I have thyroid problems (ie. hypothyroidism or hyperthyroidism)
I experience depression
I have hormone imbalances including adrenal fatigue
I have or have been diagnosed with a cancer
I have bags under my eyes when I wake up
0
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1
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2
Row 0, Column 2
3
Row 0, Column 3
0
Row 1, Column 0
1
Row 1, Column 1
2
Row 1, Column 2
3
Row 1, Column 3
0
Row 2, Column 0
1
Row 2, Column 1
2
Row 2, Column 2
3
Row 2, Column 3
0
Row 3, Column 0
1
Row 3, Column 1
2
Row 3, Column 2
3
Row 3, Column 3
0
Row 4, Column 0
1
Row 4, Column 1
2
Row 4, Column 2
3
Row 4, Column 3
0
Row 5, Column 0
1
Row 5, Column 1
2
Row 5, Column 2
3
Row 5, Column 3
0
Row 6, Column 0
1
Row 6, Column 1
2
Row 6, Column 2
3
Row 6, Column 3
0
Row 7, Column 0
1
Row 7, Column 1
2
Row 7, Column 2
3
Row 7, Column 3
0
Row 8, Column 0
1
Row 8, Column 1
2
Row 8, Column 2
3
Row 8, Column 3
0
Row 9, Column 0
1
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0
Row 10, Column 0
1
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2
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1
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11
Chronic Conditions Average Score
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12
Chronic Conditions Total Score
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13
Attachment and Neurodevelopment
*
This field is required.
0 = not true at all / does not relate to you at all 1 = true to a small degree / having a small but noticeable impact on your daily life 2 = true to a moderate degree / having a moderate impact on your daily life 3 = true to a large degree / having a significant impact
0
1
2
3
I have had the thought that if people really knew me, they wouldn’t like me and would leave
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
I don’t trust myself to follow through
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
I feel empty inside
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
It’s hard for me to relax and play and may need to use a substance to help me
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
I prefer to keep emotions out of it
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
My body and muscles feel tight
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
I had birth trauma (born prematurely, born with cord around neck, went to NICU, etc.)
Row 6, Column 0
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Row 6, Column 2
Row 6, Column 3
I experienced a significant disruption during the first 3 years of my life (abandonment, adoption, loss of a parent, medical trauma, etc.)
Row 7, Column 0
Row 7, Column 1
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Row 7, Column 3
My relationship patterns in my life are to either hold on too tight or to let go and push away
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
I have had the thought that if people really knew me, they wouldn’t like me and would leave
I don’t trust myself to follow through
I feel empty inside
It’s hard for me to relax and play and may need to use a substance to help me
I prefer to keep emotions out of it
My body and muscles feel tight
I had birth trauma (born prematurely, born with cord around neck, went to NICU, etc.)
I experienced a significant disruption during the first 3 years of my life (abandonment, adoption, loss of a parent, medical trauma, etc.)
My relationship patterns in my life are to either hold on too tight or to let go and push away
0
Row 0, Column 0
1
Row 0, Column 1
2
Row 0, Column 2
3
Row 0, Column 3
0
Row 1, Column 0
1
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2
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3
Row 1, Column 3
0
Row 2, Column 0
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2
Row 2, Column 2
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Row 2, Column 3
0
Row 3, Column 0
1
Row 3, Column 1
2
Row 3, Column 2
3
Row 3, Column 3
0
Row 4, Column 0
1
Row 4, Column 1
2
Row 4, Column 2
3
Row 4, Column 3
0
Row 5, Column 0
1
Row 5, Column 1
2
Row 5, Column 2
3
Row 5, Column 3
0
Row 6, Column 0
1
Row 6, Column 1
2
Row 6, Column 2
3
Row 6, Column 3
0
Row 7, Column 0
1
Row 7, Column 1
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0
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1
Row 8, Column 1
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3
Row 8, Column 3
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14
Attachment and Neurodevelopment Average Score
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15
Attachment and Neurodevelopment Total Score
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16
OVERALL TOTAL SCORE
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17
OVERALL TOTAL SCORE
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18
Name
First Name (optional)
Last Name (optional)
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19
Email
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A guide explaining what your answers indicate will be emailed to you immediately after completing this quiz. Any information provided to us will be kept confidential.
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