ASSESSMENT OF POST TRAUMATIC STRESS DISORDER Form 2 - One-Week Symptom Status Version INSTRUCTIONS: The time frame for each symptom is the past week. Using the prompt questions or comparable alternatives, and appropriate follow-up questions, first the FREQUENCY over the past week of the identified questions. Next, using the same method,evaluate the INTENSITY of symptom occurrence. The descriptors for the anchor points of both the frequency and intensity dimensions can be read to the patient in arriving at the most accurate rating. A. The Traumatic Event: B. The Traumatic Event is persistently re-experienced: (1) recurrent and intrusive distressing recollections of the event Frequency In the past week, have you experienced unwanted memories of the event, without exposed to something that you reminded you of the event? Did these memories occur while you were awake, or only in dreams? (Exclude if menories only occur during dreams) How often? Intensity At their worst, how much distress did these being memories cause you? Did these memories cause you to stop what were doing? Are you able to dismiss the memories if you try? 0 1 2 Never Once Two or three times 0 1 2 still 3 Four or five times 4 Daily or almost every day manageable, some disruption of activities 3 Severe, considerable distress, marked disruptionof activities, difficulty dismissing memories 4 Extreme, incapacitatingdistress, unable to continue with activities unable to dismiss memories None Mild, minimal distress Moderate, distress clearly present but (2) intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma