Working with military members — particularly those heroes returning from Afghanistan/Iraq  — we have found the following questionnaire useful to begin reaching the core of their medical issues .       

            

PTSD QUESTIONNAIRE

While you were in the military, were you ever treated for PTSD? Have you ever been treated for the symptoms of this condition in civilian life?

This questionnaire is in two parts.  We encourage you to work Part I first, then turn to Part II and comment on anything that applies to you.

 

PART ONE

Think about what PTSD looks like — see if any of the following applies to you.  If they do, tell me about them—

 

1. Repeated and disturbing memories or thoughts.

 

2. Bad dreams.

 

3. Suddenly feeling as if the stressful military experience was happening all over again.

 

4. Feeling upset because something reminds you of the stressful Gulf War or Afghanistan/ Iraq experience.

 

5. Physical reactions such as heart pounding, trouble breathing or sweating when something reminds you of the war.

 

6. Avoiding activities or situations because they remind you of the war.

 

7. Trouble remembering important parts of that military experience.

 

8. Loss of interest in things you used to enjoy.

 

9. Feeling distant or put off from other people.

 

10. Feeling emotionally numb or being unable to display your feelings for those close to you.

 

11. Feeling that your future will somehow be cut short.

 

12. Trouble falling asleep.

 

13. Irritation.

 

14. Angry outbursts.

 

15. Difficulty concentrating.

 

16. Being super vigilant or watchful.

 

17. Feeling that you have to be on guard.

 

18. Feeling jumpy.

 

19. Easily startled.

 

20. Wanting to sit in a public place with your back to the wall so you can be safe.

 

21. Being troubled by 4^th of July firecrackers or sudden noises of planes going overhead.

 

22. Difficulty driving a car, especially at night or when you see a strange/unknown object on the side of the road.

 

23. Seeing people in Middle Eastern garb and becoming apprehensive.

 

24.   Remembering incoming mortars and the constant fear.

 

25. Experience that your heart is beating heavily more than normal.

 

26. A desire for the chaos and disorder of the war zone all over again.

 

27. Attending various counseling sessions with others who feel the same way.

 

28.  Great changes in weight.

 

29. Changes in things you used to care for and do not at the present time.

 

 

PART TWO

 

Here is another approach to look at matters—this time, in terms of the physical, cognitive, emotional, behavioral, and spiritual aspects of PTSD.   Some of these matters may repeat items listed above.  Please consider whether the following apply to you, and tell me about anything we did not handle above in Part One.

PHYSICAL MATTERS

1. Tense muscles/stiffness
2. Problems eating
3. Problems sleeping
4. Chronic fatigue
5. Sexual dysfunction
6. Tremors/jitters
7. Headaches or  backaches
8. Diarrhea or constipation
9. Chest pain, rapid heartbeat
10. Weight gain or loss
11. Skin breakouts (hives, eczema)
12. Frequent colds
13. Nausea, dizziness

 

 COGNITIVE MATTERS  

1. Memory problems
2. Indecisiveness
3. Inability to concentrate
4. Trouble thinking clearly
5. Poor judgment
6. Seeing only the negative
7. Anxious or racing thoughts
8. Constant worrying
9. Loss of objectivity
10. Fearful anticipation

 

EMOTIONAL MATTERS

1. Anxiety
2. Mood swings
3. Irritability
4. Worry
5. Nightmares
6. Reactions to loud noises
7. Moodiness
8. Agitation
9. Impatience
10. Inability to relax
11. Feeling tense and “on edge”
12. Feeling overwhelmed
13. Sense of loneliness and isolation
14. Depression or general unhappiness

 

BEHAVIORAL MATTERS

1. Impulsive / addictive behavior
2. Frequent accidents or mistakes
3. Decreased attention span
4. Forgetfulness
5. Isolation
6. Lack of commitment to work or school
7. Eating more or less
8. Sleeping too much or too little
9. Isolating yourself from others
10. Procrastination, neglecting responsibilities
11. Using alcohol, cigarettes, or drugs to relax
12. Nervous habits (e.g. nail biting, pacing)
13. Teeth grinding or jaw clenching
14. Overdoing activities (e.g. exercising, shopping)
15. Overreacting to unexpected problems
16. Picking fights with others

 

 SPIRITUAL MATTERS

1. Doubt, loss of faith or trust
2. Anger towards God
3. Hopelessness
4. Cynicism
5. Martyrdom and a loss of direction
6. Inability to forgive
7. Increased or transformed faith-life
8. Changes in your meaning of life