1 In the past month, have you ever had unwanted memories of the traumatic event?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How much distress did the memories cause you?
None
Mild - mild disruption o f activities Moderate - some disruption o f activities Severe - marked disruption o f activities Extreme - extreme disruption o f activities 2 In the past month, have you ever
had unpleasant dreams about the event?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How much distress did the dreams cause you?
None
Mild - mild disruption o f sleep Moderate - some disruption o f sleep Severe - marked disruption o f sleep Extreme - extreme disruption o f sleep 3 In the past month, have you ever
suddenly acted or felt as if the event were happening again?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How much did it seem like the event was happening again?
Not at all A little bit It was quite real It was very real It was extremely real 4 In the past month, have you gotten
emotionally upset when something reminded you of the event?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How much distress did the reminders cause you?
None
Mild - mild disruption o f activities Moderate - some disruption o f activities Severe - marked disruption o f activities Extreme - extreme disruption o f activities 5 In the past month, have you ever
had any physical reactions (i.e. heart racing, sweating or feeling shaky) when something reminded you of the event?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How strong were the reactions?
No physical reactions Mild physical reactions Moderate physical reactions Severe physical reactions Extreme physical reactions 6 In the past month, have you ever
tried to avoid thoughts or feelings about the event?
How much effort did you make to avoid thoughts or feelings about the event?
7 In the past month, have you tried to avoid certain activities, places or people that reminded you of the event?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How much effort did you make to avoid activities, places or people?
No effort
A little bit o f effort Quite a bit o f effort Lots o f effort
Huge amounts o f effort 8 In the past month, have you had
difficulty remembering some important part of the event? No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How much difficulty did you have recalling important parts of the event?
No difficulty
A little bit o f difficulty Quite a bit o f difficulty Lots o f difficulty
Huge amounts o f difficulty 9 In the past month, have you been
less interested in activities that you used to enjoy?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How strong was your loss of interest?
No loss o f interest Mild loss o f interest
Quite a bit o f loss o f interest Marked loss o f interest Complete loss o f interest 10 In the past month, have you felt
distant or cut off from other people?
No
Very little o f the time Some o f the time Much o f the time Most or all the time
How strong were your feelings of being distant or cut off from others?
No fêelings of being cut o ff Mildfeelings o f being cut o ff Definite feelings o f being cut o ff Severe feelings o f being cut o ff
Extremely strong feelings o f being cut o ff 11 In the past month, have there been
times when you felt emotionally numb or had trouble experiencing feelings like love or happiness? No
Very little o f the time Some o f the time Much o f the time Most or all the time
How much difficulty did you have
experiencing emotions like love or happiness?
No difficulty
A little bit o f difficulty Quite difficult to experience Severe difficulty
Extreme difficulty 12 In the past month, have there been
times when you felt there is not need to plan for the future, that somehow it will be cut short? No
Very little o f the time Some o f the time Much o f the time Most or all the time
How strong was this feeling that your future would be cut short?
No feelings that it would be cut short Mildfeelings that it would be cut short Strong feelings that it would be cut short Severe feelings o f that it would be cut short Extremely strong feelings that it would be short
13 In the past month, have you had any problems falling or staying asleep?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How much of a problem did you have with your sleep?
No problem
A little bit o f a problem Quite a bit o f a problem A severe problem An extreme problem 14 In the past month, have you felt
especially irritable or showed strong feelings of anger? No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How strong was your anger?
No anger Mild anger
Quite a bit o f anger Severe anger Extreme anger 15 In the past month, have you found
it difficult to concentrate on what you were doing or on things going on around you?
No
Very little o f the time Some o f the time Much o f the time Most or all the time
How difficult was it for you to concentrate?
No difficulties A little difficulty Quite a bit o f difficulty Severe difficulties Extreme difficulties 16 In the past month, have you been
especially alert or watchful even when there was no real need to be? No
Very little o f the time Some o f the time Much o f the time Most or all the time
How hard did you try to be watchful of things going on around you?
/ didn 7 try
/ tried a little bit
I tried hard to be watchful I tried really hard
I tried extremely hard 17 In the past month, have you had
any strong startle reactions? No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How strong were these startle reactions?
No startle reactions Mild startle reactions Strong startle reactions Severe startle reactions Extreme startle reactions 18 Overall, how much distress have
the symptoms mentioned in this questionnaire caused you in the past month?
No distress M ild distress Moderate distress Severe distress
Overall, how much have the symptoms
mentioned in this questionnaire affected your relationships?
No impact Mild impact Moderate impact Severe impact
19 Overall, how much have the symptoms affected your ability to work? No impact M ild impact Moderate impact Severe impact Extreme impact
20 In the past month, have you felt guilty about anything you did or didn’t do during the event? No
Very little o f the time Some o f the time Much o f the time Most or all the time
How strong were these feelings of guilt?
No feelings o f guilt Mildfeelings o f guilt Strong feelings o f guilt Severe feelings o f guilt Extreme feelings o f guilt 21 In the past month, have there been
times when you felt out of touch with things going on around you? No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How strong was this feeling of being out of touch?
No feelings o f being out o f touch Mildfeelings o f being out o f touch Strong feelings o f being out o f touch Severe feelings o f being out o f touch Extreme feelings o f being out o f touch 22 In the past month, have there been
times when things going on around you have seemed unreal or very unfamiliar?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How strong was this feeling?
Not strong Mild Quite strong Very strong Extremely strong 23 In the past month, have there been
times when you felt as if you were outside of your body, watching yourself as if you were another person?
No
Once or Twice Once or Twice a Week Several Times a Week Daily or Almost Every Day
How strong was this feeling?
Not strong Mild Quite strong Very strong Extremely strong