LIST OF SYMPTOMS FOR ADULTS AND ADOLESCENTS
Please check all that apply
Since what happened, I, ________________________________:
Have intrusive images and thoughts about the events that occurred
Have had nightmares
Have had feelings that what happened is happening again
Anxiety without knowing what the cause is
Avoid activities, people, and places that remind me of what happened
Avoid activities that I enjoyed before
Feel isolated and separated from others
Lost feelings even towards family members / constantly feel emotionally numb
Fear that my loved ones / family members will die young
Have difficulty sleeping
Am easily irritated and/or mood swings
Have difficulty concentrating
Feel that I am always being watched / constantly feel that something bad is going to
happen
Am constantly overwhelmed
Feel that what is around me is not real
Have had trouble in remembering what happened
Have had tense muscles
Have been fatigued
Have had head aches, stomach aches and have felt more sick that usual
Constantly worry about everything
Have had panic attacks
Feared leaving my house by myself
Had trouble remembering what happened a couple of hours prior / am unable to
explain how I arrived somewhere
Feel desperation
Constantly feel angry
Have depression
Feel like dying / contemplate suicide
Have decreased or increased sexual interest
Have increased my use of prescription drugs
Have increased my use of illegal drugs and/or alcohol
Have felt like killing someone
Noticed that what used to scare me no longer scares me
Pay less attention to my safety
Have injured myself (cut, burned, scratched)
Other: