Page 133 - A Soldiers Exposition
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1.   I have symptoms of re-experiencing or reliving the traumatic event:
                          ▪   Have bad dreams or nightmares about the event or something like it
                          ▪   Behave or feel as if the event were happening all over again (this is known as having
                              flashbacks)
                          ▪   Have a lot of strong or intense feelings when I am reminded of the event
                          ▪   Have a lot of physical sensations when I am reminded of the event (for example, my
                              heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I'm going to
                              lose control)


                  2.  I have symptoms of avoiding reminders of the traumatic event:
                          ▪   Avoid thoughts, feelings, or talking about things that remind me of the event
                          ▪   Avoid people, places, or activities that remind me of the event
                          ▪   Have trouble remembering some important part of the event

                  3.  I have noticed these symptoms since the event happened:
                          ▪   Have lost interest in, or just don't do, things that used to be important to me
                          ▪   Feel detached from people; find it hard to trust people
                          ▪   Feel emotionally "numb" or find it hard to have loving feelings even toward those who
                              are emotionally close to me
                          ▪   Have a hard time falling or staying asleep
                          ▪   Am irritable and have problems with my anger
                          ▪   Have a hard time focusing or concentrating
                          ▪   Think I may not live very long and feel there's no point in planning for the future
                          ▪   Am jumpy and get startled or surprised easily
                          ▪   Am always "on guard"

                  4.  I experience these medical or emotional problems:
                          ▪   Stomach problems
                          ▪   Intestinal (bowel) problems
                          ▪   Gynecological (female) problems
                          ▪   Weight gain or loss
                          ▪   Pain, for example, in back, neck, or pelvic area
                          ▪   Headaches
                          ▪   Skin rashes and other skin problems
                          ▪   Lack of energy; feel tired all the time
                          ▪   Alcohol, drug, or other substance use problems
                          ▪   Depression or feeling down
                          ▪   Anxiety or worry
                          ▪   Panic attacks
                          ▪   Other symptoms such as: ______________________________

               Summing it up:

               If you checked off some of the symptoms above, it is important for you to let your health care provider
               know.

               This information helps providers plan your medical treatment. It can also help them connect you with the
               services you may need.

               If you think you may have PTSD, print this checklist, fill it out, and take it to a health care provider, or
               someone you trust.

                                                   Date Created: 07/05/2007
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