Has the person experienced or witnessed a traumatic event?

Did the event involve actual or threatened death or serious injury to the person or others?

Did the event pose a threat to the physical integrity of the person or others?

Did the patient respond to the event with intense fear, helplessness and/or horror?

Has the patient shown any of the following symptoms during or after experiencing the distressing event:

• a subjective sense of numbing, detachment or absence of emotional responsiveness?

• a reduction in awareness of his or her surroundings ('being in a daze')?

• a sense of derealization?

• depersonalization?

• dissociative amnesia (unable to recall an important aspect of the trauma)?

Has the patient?

• had recurring images, thoughts, dreams illusions, flashbacks to the event?

• had a sense of reliving the experience?

• shown distress when exposed to reminders of the event?

• shown marked avoidance of stimuli (thoughts, feelings, conversations, activities, places, people) that might arouse recollections of the event?

Does the patient show?

• difficulty sleeping?

• irritability?

• poor concentration?

• hypervigilance?

• exaggerated startle response?

• motor restlessness?

• significant distress or impairment in social, occupational, or other important areas of functioning?

• impaired the ability of the person to pursue some necessary task?

Could any of the following explain the disturbance:

• a side effect of medication?

• alcohol or other abused substance?

• complication of a medical condition?

• a brief psychotic disorder?

• an exacerbation of a preexisting Axis I or II disorder?

How many days has the disturbance lasted?

How many days after the traumatic event was the onset of the disturbance?


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