¹
1
2
1
Have you ever experienced this kind of event?
2
In the past month, have you...
had nightmares about the event(s) or thought about the event(s) when you did not want to?
3
tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)?
4
been constantly on guard, watchful, or easily startled?
5
felt numb or detached from people, activities, or your surroundings?
6
felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused?
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.