Trauma&Screening&QuestionnaireThis'questionnaire'is'concerned'with your'personal'reactions'to'the'traumatic'event'which'happened to'you.'Please'indicate'(Yes/No)'whether'or'not'you'have'experienced any'of'the'following'at'least'twice'in'the'past'week.No Yes1. Upsetting'thoughts'or'memories'about'the'event'that'have'comeinto'your'mind'against'your'will2. Upsetting'dreams'about'the event3. Acting'or'feeling'as'though'the'event'were'happening again4. Feeling'upset'by'reminders'of'the'event5. Bodily'reactions(such'as'fast'heartbeat,'stomach'churning,sweatiness,'dizziness) when'reminded'of'the'event6. Difficulty'falling'or'staying'asleep7. Irritability'or'outbursts'of'anger8. Difficulty'concentrating9. Heightened'awareness'of'potential'dangers'to'yourself'and others10. Being'jumpy'or'being'startled'at'something'unexpectedIf'you'have'answered'yes'to'6'or'more'questions'you'are'encouraged'to'consider'whether'you'think'that'some'counseling'support'may'be'of'benefit'in'helping'you'to'lower'your'onXgoing'reactions'to Quiz Logo

  • This brief survey is designed to help you better understand how recent experiences may have impacted your well-being and identify possible signs of trauma.

    Your honest responses will guide you in recognizing patterns and determining whether additional support or resources might be helpful.

  • 1. I am so ashamed of what happened to me that I sometimes want to escape from myself.

  • 2. My traumatic experience has revealed a part of me that I am ashamed of.

  • 3. Because of what happened to me, I am disgusted with myself.

  • 4. I often try not to not talk/think about stressful experience(s) to minimize negative feelings

  • 5. I often Have outbursts of anger or irritable behavior

  • 6. It is difficult to experience positive emotions (ex. unable to feel happy or feel love towards people close to you)

  • 6. Have you experienced one or more events within the last year death of a loved one, serious illness or injury (self or close family), natural disaster (e.g., hurricane, flood, fire), physical assault or abuse, emotional or psychological abuse, sexual assault or harassment, domestic violence of a significant relationship (e.g., breakup, divorce), major accident (car, workplace, etc.),financial hardship or job loss, homelessness or unsafe living conditions, Sudden/unexpected move or displacement, diagnosis of a serious mental health condition, major life transition (e.g., becoming a parent, retirement)?

  • 6. Have you experienced one or more events within the last year death of a loved one, serious illness or injury (self or close family), natural disaster (e.g., hurricane, flood, fire), physical assault or abuse, emotional or psychological abuse, sexual assault or harassment, domestic violence of a significant relationship (e.g., breakup, divorce), major accident (car, workplace, etc.), financial hardship or job loss, homelessness or unsafe living conditions, Sudden/unexpected move or displacement, diagnosis of a serious mental health condition, major life transition (e.g., becoming a parent, retirement) before the age of 18?:

  • 7. I am easily startled or “jumpy”

  • 8. I am bothered by nightmares and intrusive thoughts often.

  • 9. I avoid certain people, places, and types of people in order to maintain my peace.

  • 10. I find it difficult to adjust after criticism.

  • If you answered “somewhat true of me” for over 6 of the questions:
    This may suggest that you are experiencing moderate levels of trauma-related impact in your daily life. It could be helpful to reflect on these areas and consider seeking supportive resources or speaking with a mental health professional for guidance and coping strategies.

    If you answered “That’s me” for over 5 of the questions:
    This may indicate that trauma is strongly affecting your well-being and functioning. You are encouraged to reach out to a qualified professional for personalized support, assessment, and assistance in your healing process.

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