Trauma Questionnaire

Guidance for completion

This questionnaire aims to identify if you persistently/regularly experience any of the following.

Please tick YES or NO for all of the questions below

#Question
Select
SECTION AYesNo
1Do you keep having intrusive, distressing memories of your birth, including upsetting images, thoughts or perceptions?
2Do you have nightmares about your birth?
3Do you keep reliving the traumatic events of your birth, or keep having flashbacks?
4Do you feel anxious or panicky when something reminds you of your birth?
5Have you begun to experience any physical symptoms or problems when something reminds you of your birth? For example, asthma, stomach upsets/irritable bowel, etc.?
 
SECTION BYesNo
6Do you try to avoid thinking, or talking, about your birth because you find it too distressing?
7Do you avoid activities, places or people that remind you of your birth?
8Do you find it hard to remember important aspects of your birth?
9Have you lost interest in activities you used to enjoy?
10Do you feel disconnected and distant from those who would normally be close to you, such as family or friends?
11Do you feel unable to have, or express, loving feelings towards those close to you, including your child, family or friends?
12Do you feel like you have no hopes or positive thoughts about the future?
 
SECTION CYesNo
13Do you have difficulty falling, or staying, asleep?
14Do you feel irritable, or have outbursts of anger?
15Do you have difficulty concentrating?
16Are you hyper-vigilant (constantly watching out for danger)?
17Do you constantly feel jumpy?
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