Dr Elaine Tripi - PTSD Self Test For Women

P.T.S.D. Self Test For Women

ELAINE M. TRIPI, Ph.D.

Your information is being kept confidential and is only being sent directly to Dr. Tripi.

Section A: Can you answer yes to the following questions? Can you answer yes to the following questions? 1. Have you ever been in a war, either as a combatant, a medic, a prisoner of war, or a member of a support team or grave registration unit? 2. Were you ever, in any way exposed to combat, enemy or friendly fire, or atrocities? 3. Were you ever sexually assaulted, intimidated, raped or intimidated by fellow military members or superiors - either male or female, enlisted or officers?	Section A Yes: No:

Section B: Can you answer yes to the following questions? 1. Do you, on a persistent or recurring basis, find yourself having intrusive or involuntary thoughts of the traumatic event? 2. Do you have dreams or nightmares about the event? 3. Do you have dreams or nightmares that are not replays of the actual event, but contain some of the aspects of the event (i.e. location, feelings, people)? 4. Do you find yourself acting or feeling as if you were back in the original traumatic situation? 5. Do you become extremely upset around people, places, or events that resemble an aspect of the original trauma? 6. Do you become distressed around the anniversary date of the trauma? 7. Do you have physical symptoms when exposed to events that are similar to or symbolize the traumatic event?	Section B Yes: No:

Section C: Can you answer yes to the following questions? 1. Since the traumatic event, are there periods of time when you feel numb or dead inside, or difficulties feeling close to others? 2. Do you try to avoid thoughts or discussions about the event? 3. Since the traumatic event, have you felt alienated and apart from others? 4. Have you had a sense of doom of foreboding since the event? Do you feel that you will die young or never experience the rewards of life? 5. Have you lost interest in activities that you used to enjoy? 6. Are you unable to remember certain aspects of the trauma?	Section C Yes: No:

Section D: Do you experience any of the following? 1. Difficulty falling or staying asleep? 2. Outbursts of anger or irritability? 3. Difficulty concentrating? 4. Over protectiveness towards oneself or others, hyper vigilance? 5. Overreacting to noises or sudden appearance of a person?	Section D Yes: No:

Section E: Have these symptoms lasted for more that a month after the traumatic event?	Section E Yes: No:

Section F: Do you experience any of the following? 1. Difficulty concentrating? 2. Anxiety or panic attacks? 3. Memory loss (short and long term)? 4. Flashbacks or intrusive thoughts? 5. Insomnia or other sleep problems? 6. Overwhelming feelings of anger or sorrow? 7. Depression? 8. Withdrawal – alienation/isolation? 9. Freezing – being unable to move, speak, or interact?	Section F Yes: No:

If you have answered yes to criteria A, and yes to B-F criteria, you may be suffering from Post Traumatic Stress Disorder. For more information about how I can help you, fill in the form below.


Name (Required):
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Are you a veteran (Required)?	Yes: No:
Branch of Service (I.E.- Army):
Service Connected Disability (PTSD):
Additional Disability (I.E. Back):
Additional Disability (I.E. Cancer)::
Additional Disability (I.E. Knees):
Additional Disability (I.E. Skin):
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% of Disability:
% of Disability:
% of Disability:
% of Disability:
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