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For each question, answer how you have felt in the PAST WEEK.

Do you have pains in your lower back?
Do you feel blocked in getting things done?
Do you feel shy or uneasy with the opposite sex?
Do you feel lonely?
Do you feel nervous or shaky inside?
Do you have temper outbursts you cannot control?
Are you afraid in open spaces or on the streets?
Do you feel that most people cannot be trusted?
Do you feel that others can control your thoughts
Do you experience soreness in your muscles?
Do you have to check and recheck what you do?
Are your feelings easily hurt?
Are you blue?
Are you suddenly scared for no reason?
Do you have urges to beat or harm someone?
Are you afraid to go out of your house alone?
Do you feel that you are being watched by others?
Do you hear voices that others do not hear?
Do you experience hot or cold spells?
Do you have difficulty making decisions?
Do you feel inferior to others?
Do you worry too much about things?
Do you feel fearful?
Do you have urges to smash or break things?
Are you afraid to travel on subways, busses or trains?
Do others not give you proper credit for your achievements?
Do you have thoughts that are not your own?
Do you experience numbness or tingling in parts of your body?
Does your mind go blank?
Do you feel uneasy when people watch or talk about you?
Do you feel no interest in things?
Do you feel tense or keyed up?
Are you uneasy in crowds, such as shopping or at the movies?
Do you feel that people will take advantage of you?
Do you feel lonely even when you are with people?
Do you feel weak in parts of your body?
Do you have trouble concentrating?
Do you feel very self-conscious when with other people?
Do you feel hopeless about the future?
Do you have spells of terror or panic?
Do you feel that you are being punished for your sins?
Do you have feelings of heaviness in your arms or legs?
Do you feel worthless?
Do you feel so restless you can't sit still?
Do you feel something is wrong with your mind?

© 2024 by Christine Poje TraumaTherapyAmerica

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