HELPING HEROES HEAL backup

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INSTRUCTIONS: Below is a list of problems and complaints that veterans sometimes have in response to stressful military experiences. Please read each one carefully, then select one of the numbers below question to indicate how much you have been bothered by that problem in the past month.

1 . Repeated, disturbing memories, thoughts, or images of a stressful military experience? *

2. Repeated, disturbing dreams of a stressful military experience? *

3. Suddenly acting or feeling as if a stressful military experience were happening again (as if you were reliving it)? *

4. Feeling very upset when something reminded you of a stressful military experience? *

5. Having physical reactions (e.g., heart pounding, trouble breathing, sweating) when something reminded you of a stressful military experience? *

6. Avoiding thinking about or talking about a stressful military experience or avoiding having feelings related to it? *

7. Avoiding activities or situations because they reminded you of a stressful military experience? *

8. Trouble remembering important parts of a stressful military experience? *

9. Loss of interest in activities that you used to enjoy? *

10. Feeling distant or cut off from other people? *

11. Feeling emotionally numb or being unable to have loving feelings for those close to you? *

12. Feeling as if your future will somehow be cut short? *

13. Trouble falling or staying asleep? *

14. Feeling irritable or having angry outbursts? *

15. Having difficulty concentrating? *

16. Being "super-alert" or watchful or on guard? *

17. Feeling jumpy or easily startled? *

Proof of Military Service (DD214) *

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PTS(D) EVALUATION FORM

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