Patrick Teahan

CHILDHOOD PTSD QUESTIONNAIRE FULL ASSESSMENT

ANSWER (YES, NO, OR MAYBE)

Apply the question to the course of your lifetime. The issue might be resolved but still say yes – it helps with your story.

1. I've always felt that there is something wrong with me.
2. [-] I have relationship and intimacy problems.
3. I can isolate.
4. [-] I tend to get through things rather than experience and or enjoy them. (Vacations, Holidays, Projects, Shopping, Gatherings)
5. I struggle with depression and or anxiety.
6. I can have trouble feeling joy and or spontaneity.
7. I can space out, disassociate, numb out and or feel empty.
8. [-] Dysfunctional people seek me out.
9. [-] Being wrong and or right means too much to me.
10. I struggle with ambiguity – loose ends, things up in the air, people not getting back to me.
11. I can get into certain modes. (survival mode, work mode, rescue mode, emergency mode).
12. [-] When things are going well, I don’t trust it.
13. I can set myself up by being too optimistic and or can miss red flags.
14. I have a hard time with moderation and can be addicted to things. (Alcohol, food, drugs, sex, media, caffeine)
15. I’ve had or have food, sleep, or energy issues –(exhaustion or busy energy).
16. I’m out of touch with my needs/wants.
17. My libido is underactive or overactive.
18. Growing up, I could be embarrassed or humiliated by my parents.
19. Small talk can make me disinterested, irritated or uncomfortable.
20. I have difficulty tapping into anger or possibly have too much of it (standing up for myself or others).
21. I can be overly focused on fairness.
22. [-] Growing up, my parent(s) were rageful, volatile, dominating, depressed, unavailable or neurotic.
23. [-] Growing up, there was manipulation and or injustice.
24. [-] Growing up, I experienced corporal punishment.
25. Growing up, the adult’s needs and feelings came first.
26. [-] I get upset when others don’t read what is going on with me.
27. I can overpower or shut down during conflict.
28. I can have fights/arguments with people in my head.
29. I’ve been told I’m intense (too serious), or disengaged (aloof).
30. I anticipate that other people will be upset with me and or that they will let me down.
31. After an intense conversation or situation, my feelings and or thoughts catch up with me hours after a delay. Example “I should have said that!”
32. [-] I can be greatly affected by other people’s moods.
33. [-] Compliments make me uncomfortable and I minimize them.
34. Rejection puts me in a very bad place.
35. I often hide my real feelings/emotions.
36. [-] I can often view myself based on the way people react or respond to me.
37. [-] When someone is caring or nurturing I question it and feel uncomfortable.
38. My emotions and or reactions can get in the way of my functioning or prevent me from who I want to be. They've already done
39. [-] I can often feel used or taken advantage of.
40. [-] I often do not trust my own feelings or the feelings of others.
41. [-] I can be reactive or deeply affected by criticism (any kind).
42. I tend to be attracted to unavailable people.
43. I can often feel superior and or inferior to others.
44. Growing up one or both my parents were greatly dissatisfied & negative with each other or their partners if divorced.
45. I can’t stop being negative even when I try not to be.
46. [-] I feel that I’m not worthwhile unless I’m a satisfactory lover.
47. Growing up, things were not talked about. (emotions, situations, elephants in the room).
48. I’m more comfortable with one of the sexes. (male/female)
49. [-] I’ve felt inadequate about my gender.
50. I don't like being touched.
51. I’ve only ended relationships once things get very bad.
52. Because one of my parents was so bad, I consider the other one safer.
53. I’m perpetually seeking to get my life together, not feeling good enough.
54. [-] I’m perfectionistic and or rigid.
55. I struggle with procrastination and or finishing things.
56. Growing up I had feelings about killing one or both my parents which caused shame.
57. [-] One or both my parents overly confided in me growing up about their problems.
58. Angry people and people in authority freak me out.
59. I tend to think about my feelings v. feeling them fully.
60. [-] Speaking up about my needs/preferences or saying no, is difficult for me.

Add up the yeses, and then add up the yeses and maybes and average them.
Any more than ten yeses most likely means that there is some childhood exploration and or work to do. Scoring high is very common.
Use this questionnaire as a tool to bring to treatment or to establish the need for treatment with a licensed behavioral health provider.