This document contains the set of exploratory questions to help identify post-traumatic stress disorder.
To show any additional detailed question supporting text tap on the question's blue bubble.
The expression “emotional stability” is used here to define the ability to maintain a calm and balanced emotional state and manage stress and challenges without extreme reactions or mood swings.
Anxiety is the internal emotional and physical state that involves persistent worry and a prolonged, internal feeling of apprehension or dread concerning imminent or imagined future events and can persist even without a clear cause.
Cognition is the umbrella term for how the brain takes in, processes, and makes sense of information to interact with and understand the world and symptoms of cognitive anxiety can include
- persistent worry about potential problems or negative outcomes and exaggerating potential consequences
- dwelling on negative thoughts or events, even when they are not directly present
- difficulty with racing thoughts, concentration, memory, and decision making
- panic attacks, overwhelming rushes of intense mental and physical symptoms that come on very quickly, often without any obvious trigger, and last a few minutes.
Somatic relates to the body and physiological refers to its normal functions, processes, and mechanisms. Somatic anxiety describes the physiological response to cognitive anxiety and symptoms can be single, multiple or varying and range from mild to severe, and can include
- dizzying or painful headaches
- a racing heart or chest pains
- intense breathing or shortness of breath
- abdominal pains, stomachache or an upset stomach
- uncontrollable bodily trembling or shaking
- profuse sweating, even when cold
- fatigue or weakness
- tight muscles and muscle tension
- aching in one or more groups of muscle
- panic attacks, overwhelming rushes of intense mental and physical symptoms that come on very quickly, often without any obvious trigger, and last a few minutes.
How would you describe the impact of mental anxiety and any consequent anxiety-driven physical stress on your daily functioning and emotional stability?
A phobia is a potentially debilitating surge of anxiety and panic brought on by an imagined sense of fear or danger linked to something such as an object, place, situation, feeling or animal.
Symptoms can be triggered by coming into contact with the source of the phobia or by anticipatory anxiety, where thinking about the source of a phobia is enough in itself.
Examples include
- agoraphobia, the fear and avoidance of places or situations that might cause panic and feelings of being trapped or helpless
- amaxophobia, the fear of driving or riding in a vehicle such as a car, bus or plane
- erotophobia, which encompasses a broad range of anxieties and fears related to sex and physical intimacy
- gamophobia, the fear of commitment
- hoplophobia, the fear of weapons and in particular firearms
- mysophobia, the fear of germs and contamination
- somniphobia, an intense fear of sleep
- tokophobia, the fear of childbirth.
In addition to the emotional distress, a phobia can lead to significant daily disruption if it becomes so severe as to cause a person to organise their life around avoiding anything that causes them anxiety.Rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing as a result of either coming into contact with or having unsettling thoughts about anything that you have a particular fear of?
Migraine headaches include severe throbbing or pounding pain on one or both sides of the head, and can also affect the face or neck. They are debilitating enough to significantly impact daily activities.
Additional symptoms can include
- numbness or a tingling sensation on one side of the face or body
- dramatically increased sensitivity to light, sound, or smells
- having difficulty speaking or becoming incoherant
- feeling dizzy, light-headed or losing balance
- nausea, the medical term for feeling sick
- vomiting, the result of abdominal heaving, retching and forcefully ejecting the contents of the stomach and upper intestine.
Rate the frequency of your suffering from migraine headaches?
Tension headaches are typically only mildly or moderately painful, can last from at least thirty minutes up to several days and are not made worse by physical activity.
Symptoms can include- dull aching pain on both sides of your head, face or neck
- a feeling of tightness or pressure across the forehead or on the sides your head
- tenderness or aching in the scalp, neck or shoulder muscles
- your head hurting more than usual if touched.
Typically you should be able to continue with most daily activities without making the headache worse.Rate the frequency of your suffering from tension headaches?
The circadian rhythm controls the cycles your internal body clock repeats about every twenty four hours that tell you when it is time to sleep or wake.
Your body tries to synchronise your sleep-wake cycle to cues from the environment, such as seasonally adjusting to when it gets light or dark outside, when you eat, and when you are physically active.
Disruption of the circadian rhythm can affect- how well you sleep
- when you are able to sleep
- how well you function when awake.
Jet lag is a circadian rhythm sleep-wake disorder that occurs when your twenty four hour internal body clock does not match the local day-night cycle.Somniphobia describes an actual fear of sleep itself, driven by the pervasive sense of vulnerability to nightmares or unpleasant mental disturbances during a period of sleep.Rate the disruption to your sleep preparations as a result of a misaligned body clock or pre-sleep anxiety?
The phrase “post-traumatic psychological injury” is used here to describe a mental health condition that can develop after experiencing or witnessing a traumatic event.
Sleep is a critical component of mental and physical health. The disruption caused by a post-traumatic psychological injury can create a self-perpetuating cycle where negative thoughts, emotions, and actions reinforce each other, leading to a worsening state of mental and physical wellbeing.
PTSD-related insomnia can surface through- distressing dreams, nightmares or night terrors
- overthinking or rumination, the repetitive and persistent thinking for more than a few idle minutes that usually involves repeating a negative thought or trying to solve an evasive problem
- racing thoughts, which are fast-moving and often repetitive thought patterns that bounce around the mind uncontrollably without allowing time to fully process or complete any single thought
- intrusive thoughts, persistent unwanted, distressing and disturbing thoughts that often revolve around specific fears, themes, or concerns and can be graphically explicit or violent and upsetting
- earworms, songs or parts of songs that become stuck in your head and are difficult to dislodge.
Common symptoms include- difficulty falling asleep and staying asleep
- unsatisfying sleep and trouble waking up in the morning or waking up fatigued and unrefreshed
- excessive daytime tiredness and difficulty focusing or being motivated
- mood changes, particularly depression or being easily upset.
Rate the level of disruption that interference to your sleep habits caused to your sleep-wake cycle and your attempts to enjoy enough nourishing sleep to function?
Depression differs from occasional misery by being a prolonged and heavy mental state of sadness and low mood which significantly interferes with all aspects of daily life.
Symptoms can include- being uncharacteristically weepy or crying with little or no obvious cause
- an increase in the number and severity of mood swings or becoming uncharacteristically irritable
- a lack of enthusiasm for things that would normally bring pleasure
- seeming overly tired or having less energy than usual
- expressing feelings of extreme tiredness that are actually indicators of severe emotional exhaustion and a desire to escape emotional pain
- increasingly severe or frequent repetitive and compulsive behaviours
- self-harm or suicidal thoughts or urges.
To what extent has your overall emotional stability and mental wellbeing been reduced by a persistent state of low mood and loss of interest in daily life?
Post-traumatic psychological injury can lead to an increase in unhealthy behaviours and thought patterns as coping mechanisms to deal with excessive stress or difficult emotions.
Habitually harmful behaviours that are not isolated recreational pursuits include- regular and excessive alcohol intake outside socially acceptable occasions
- frequent use of drugs that are manufactured, obtained, or sold illegally and that may be impure or highly addictive
- misuse of prescription or over-the-counter drugs
- having unsafe sex.
Self-harming behaviours include- hair pulling
- forceful head shaking
- head banging on floors, walls or other surfaces
- face or head slapping
- eye gouging
- hand or arm biting
- bodily burning or cutting
- uncontrollable skin rubbing, picking, pinching, or scratching
- punching the self or hard objects
- swallowing sharp objects or drinking hazardous liquids.
Reckless and self-destructive behaviours include- frequent dangerous driving
- embracing risks, especially those that could lead to bone fractures
- exercising excessively
- feeding and eating disorders, in particular bulimia nervosa, a serious and potentially life-threatening eating disorder where someone binge eats in one sitting, often in secret, then tries to purge their body of the food, usually by vomiting or misusing laxatives.
How would you describe the level of your engagement in what could reasonably be interpreted as harmful, self-harmful, or reckless and self-destructive habits?
Rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing caused by unwanted memories or reminders of a single deeply upsetting personal experience that took place within the past four weeks?
Rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing caused by unwanted memories or reminders of multiple or repeated deeply upsetting personal experiences that took place within the past four weeks?
This question may concern a difficult subject but it is very important for maintaining historical context. Regarding any single deeply upsetting personal experience that lasted for a short period of time and took place more than four weeks prior to this assessment, please try to rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing as a result of unwanted memories or reminders of suchRegarding any single deeply upsetting personal experience that lasted for a short period of time and took place more than four weeks prior to this assessment, rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing as a result of any unwanted memories or reminders of such?
This question may concern a difficult subject but it is very important for maintaining historical context. Regarding any multiple or repeated deeply upsetting personal experiences that took place more than four weeks prior to this assessment, please try to rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing as a result of any unwanted memories or reminders of suchRegarding any multiple or repeated deeply upsetting personal experiences that took place more than four weeks prior to this assessment, rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing as a result of any unwanted memories or reminders of such?
Chronic induced trauma, also known as complex trauma, describes the accumulated damaging emotional or psychological harm that can result from being forcibly or unavoidably exposed to harrowing events or an overly stressful environment for an extended period of time.
A “toxic environment” can exist within the home, social and public settings or at a place of work or education and can lead to a person feeling persistantly frightened, intimidated, threatened, offended, discriminated against, disrespected or humiliated.Private-life induced trauma can include- neglect or abandonment
- domestic abuse, which can include physical violence, forced sexual activity or emotional abuse at any age, whether by an intimate partner or trusted figure
- coercive control, which may include physical or non-physical behaviours such as
- monitoring the victim's whereabouts and activities, including technology-facilitated abuse such accessing the victim's devices to track their contact with other people and the denial of privacy by filming or recording them in the home
- isolating the victim from their friends or family
- stopping the victim from going out or to work and forcing them to be dependent for necessary things such as food, money and housing
- threatening to hurt the victim or their family members or pets
- damaging or threatening the victim's property
- repeated insults and belittlement or threats of public embarrassment.
- stalking, whether it is driven by
- predatory urges
- resentment and anger
- seeking intimacy
- being an incompetent suitor
- rejection, most commonly by an ex-partner trying to regain an intimate relationship.
Workplace-induced trauma can include- an environment where leadership use fear, manipulation or micromanagement as tools to dominate subordinates
- a culture that lacks support and actively encourages, tolerates or habitually ignores long-term negative behaviours or practices such as
- exposure to workplace violence
- offensive behaviour, words, or displays designed to cause alarm or distress, including
- abusive or insulting language
- harassment or intimidation
- social, verbal, or physical bullying
- any form of discrimination or unfair treatment based on identity
- unreasonable expectations
- unreasonable workloads
- organisational instability
- job insecurity.
Chronic induced trauma can have lasting psychological and physical consequences including headaches, insomnia, anxiety, depression, and long-term pain.This question may concern a difficult subject but it is very important for maintaining historical context. Regarding any previous or ongoing deeply upsetting experiences that happened repeatedly and over a prolonged period of time, rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing caused by unwanted memories or reminders of suchRegarding any previous or ongoing deeply upsetting experiences that happened repeatedly and over a prolonged period of time, rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing caused by unwanted memories or reminders of such?
Uninvited but manageable loops of persistant overly-detailed thinking can take the form of rumination, specifically concerned with past events and what happened in the time around them, or overthinking, which focuses on current events or future scenarios.
Ruminative thinking dwells on particular but abstract segments of a past event timeline and common themes include questioning- your actions at the time of the event, both in the context of what you did and what you did not do
- whether you should have done something differently and if so how that might have changed the outcome
- the reasons that you think provide evidence of you being responsible
- the reasons that you think provide evidence of someone or something else being responsible
- whether and how much you will recover and what life will be like then
- whether you are losing control of yourself as a result of intrusive thoughts and memories.
Overthinking is a state of excessive and repetitive thinking about a present happening or imagined sequence of future events or actions to try to predict outcomes or find solutions. It can result in analysis paralysis, whereby the person becomes so bogged down in overanalysing a situation that it becomes impossible for them to make a decision or take action.Neither rumination or overthinking lead to a complete and successful resolution of a problem despite repeated mental re-running.
Rate the impact on your mental wellbeing and day-to-day functioning of uninvited mental analysis of previous experiences, present events, or future scenarios?
The phrase “intrusive thinking” is used here to describe any unwanted and unwelcome thought or memory that forces its way into your mind without warning and can cause anxiety.
Intrusive thoughts can happen quickly and often and usually revolve around specific fears, themes, or concerns. Intrusive memories contain strong sensory-provoking components such as seeing images, hearing sounds, or feeling physical sensations and emotions associated with all or fragmented parts of a previous experience.
Intrusive repetitive negative thinking describes- the negative aspect of thinking when in a calm or contemplative state by repeatedly replaying past actions, unresolved conflicts, or conversations, analysing what was done or said, then imagining different outcomes or responses
- the repetition of a particular thought, often in response to a trigger or stressor and potentially contributing to repetitive behaviours and routines.
Intrusive negative automatic thought patterns include- excessive worrying about tasks that need to be completed and potential negative outcomes, even if the task is neither imminent nor urgent
- focusing on the same thoughts repeatedly through boredom as a way to pass the time or distract themselves from their feelings or their current situation.
Intrusive aggressive thoughts can be graphically explicit or violent and upsetting and can include- dark thoughts that vividly imagine horrifying or violent events being inflicted on themselves, things they hold affection for, or things that are fragile and easily damaged
- intrusive sexual thoughts, fantasies and urges, potentially leading to above-average or unusual sexual behaviours and interests.
Less intense than flashbacks, which involve reliving the past, and unlike typical memories, which are the result of an experience being processed and encoded into a coherent recollection, intrusive memories are often poorly integrated. They can feel like highly disturbing snippets of an event and are capable of causing significant emotional distress.Rate the impact on your mental wellbeing and day-to-day functioning of intrusive thoughts or sensory-provoking memories?
Traumatic flashbacks are involuntary memory intrusions where the mind spontaneously re-experiences all or part of a traumatic event with accompanying physical and emotional distress that is often so vivid as to create a palpable feeling of actually reliving the past as a present-day experience.
Intrusive flashbacks are often triggered by sensory cues from the surrounding environment that act as reminders of a traumatic event. They primarily involve re-experiencing sights, sounds, and emotions associated with a previous happening in a way that is so vivid as to make the person feel as if they were back at the original scene and actually reliving all or part of it.Emotional flashbacks primarily cause a person to re-experience the intense emotions associated with a traumatic event and become overwhelmed by fear, sadness, anger, or shame, often without a clear understanding of why such feelings were triggered.
Rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing of experiencing flashbacks that focused on all or parts of anything from the past that caused you significant pain or upset?
A nightmare is a terrifying or disturbing dream that is so vivid as to cause powerful surges of negative emotion that can result in sleep being severely disrupted. Post-traumatic psychological injury can cause nightmares to transform from recreating original events into gross or shocking abstract dreams.Rate the level of disruption that nightmares, bad dreams and accompanying bad thoughts caused to your sleep-wake cycle and your attempts to enjoy enough nourishing sleep to function?
Social interaction is a dynamic and unpredictable sequence of social actions between individuals or groups and post-traumatic stress can make it an emotionally intense and isolating experience.
Social anhedonia describes a significant lack of interest in social contact coupled to a reduced ability to derive pleasure from social situations, and symptoms include- social withdrawal or isolation
- reduced interest in social contact and interaction
- a reduced ability to derive pleasure from interpersonal experiences
- a lack of close friends and intimate relationships, and decreased quality of those relationships
- difficulty adjusting to social situations
- depressed mood.
Social fatigue can occur after having engaged in full social interaction, and markers can include- an onset of tiredness or exhaustion shortly after a social activity
- wanting or needing time away from social situations to recharge after a social activity
- experiencing heightened post-activity anxiety and stress, such as
- headaches
- difficulty concentrating
- difficulty sleeping
- increased moodiness.
- post-activity meltdown
- post-activity onset of depression.
The feelings of a social interaction “hangover” can range from mild fatigue through to exhaustion and last from a few hours to days after the event has finished.How would you describe your approach to allowing regular social interaction to form a normal part of your everyday life?
Post-traumatic psychological injury can cause a person to intentionally stay away from places, people, objects, thoughts and feelings, or any other related thing that might remind them of or cause them to have to think about a deeply upsetting event or experience.
How would you describe any difficult-to-control urges to avoid someone, somewhere or something that has an historical connection to events associated with a deeply upsetting experience?
Post-traumatic psychological injury can cause a person's mind to become trapped in an anxious spiral of unwanted obsessions and reactive complusions related to imagined potential disasters or terrible consequences if specific rituals are not performed exactly as required.
The obsessions are intrusive anxiety-inducing thoughts, mental images, or urges that occur over and over again, examples being- a preoccupation with wondering whether things such as appliances, locks, or switches have been set in a particular way
- engaging in mental reassurance by repeatedly going over details of whether an action has been completed despite being knowing that it has.
The compulsions are rituals a person feels obliged to act out in order to relieve the distress caused by the obsessions and examples include- a preoccupation with repeatedly checking that things such as appliances, locks, or switches have been set in a particular way
- repeatedly asking for confirmation that something has been completed in a set way
- taking an abnormally long time to complete relatively simple activities.
Rate the intensity of difficult-to-control obsessive thoughts and compulsive behaviours, especially ones that involve the need to reassure yourself that things you worry about have been set in a particular way?
Healthy busyness describes being engaged in meaningful, enjoyable, or goal-oriented activities through choice, regardless of what you are feeling emotionally, and the activity bringing a true sense of purpose and achievement.Compulsive busyness is an anxiety-driven behaviour that involves keeping occupied with activities that are not always required at the time or fulfilling but that provide a useful distraction from negative thoughts and emotions.
Rate the level of disturbance to your daily flow caused by difficult-to-control urges to keep busy, regardless of the actual value or necessity of the task you were occupied with?
Depersonalization-derealisation occurs when a person feels as if they are seeing themselves from outside their body or have a sense that things around them are surreal. Whilst sometimes described as seeing the world in a dream-like state, the associated feelings can be emotionally disturbing and significantly disrupt daily activities and relationships.
Depersonalisation is a mental state where a person has the feeling of being outside themself and observing their actions, feelings or thoughts from a distance and not always in full control of their body movements.Symptoms can include- feeling as if your body or self is unreal or separate
- feeling like an observer who is experiencing yourself as if watching a movie or looking in from the outside
- feeling like a robot and having a sense of being controlled by an outside force or lacking control over your actions.
Derealisation is a mental state where a person feels detached from their surroundings and sees the world as unreal, dreamlike, or distorted.Symptoms can include- feeling as if the world is unreal, dreamlike, or foggy
- familiar places seeming foreign or strange
- feeling physically disconnected from your surroundings and people
- objects seeming to be distorted, such as appearing larger, smaller, blurry, or flattened
- time feeling distorted by speeding up or slowing down
- sounds seeming muffled or unusually sharp
- vibrant colours appearing muted or washed out.
Dissociative flashbacks are often characterised by a feeling of detachment from oneself or the world in such a way as to feel as if observing a traumatic event from a distance or even experiencing it from a third-person perspective. Dissociative flashbacks can lead to a sense of numbness, confusion, and disorientation.Rate the level of disturbance from strange or surreal experiences of feeling detached from yourself or disconnected from the reality of the world around you?
Auditory hypersensitivity is a condition which triggers significantly heightened emotional and physical reactions to the sensory stimulation caused by sound. Normal environmental noises can seem uncomfortably loud, penetrating, painful, or frightening. If a sound is linked to a traumatic memory it can lead to a surge in anxiety and stress and emotions such as disgust, irritation, anger or rage. It may also trigger a flashback.
Hyperacusis causes the sufferer to experience everyday sounds as seeming much louder than they should, leading to pain and discomfort, for example- blue-light sirens
- dogs barking
- electrical devices such as phone ringtones, washing machines, or vacuum cleaners
- running water
- walking on leaves or gravel.
Misophonia is a disproportionate emotional reaction to certain everyday sounds that should be relatively easy to filter out and is often triggered by- mouth, nose and throat sounds, particularly those produced by chewing or eating and drinking
- repetitive environmental sounds produced by other people or objects
- sounds produced by animals.
Ligyrophobia is a fear of devices and activities that can suddenly emit loud sounds, such as speakers or fireworks. Certain occasions, such as parades and carnivals, that are accompanied by very loud instruments can lead to agoraphobia, a fear and avoidance of places or situations that might cause panic and feelings of being trapped or helpless.How would you describe your reactions to sounds that were uncomfortably distressing or any need they set up in you to avoid their source?
Hypervigilance is a potentially exhausting condition in which the nervous system becomes persistently and recurrently dysregulated, causing a release of excessive stress signals that lead to inappropriate and exaggerated responses. It can lead to becoming trapped in a state of high alert and unable to control urges to constantly scan the surrounding environment for potential risks or threats, even in safe situations.
Often brought on as a result of real-world experiences, hypervigilance can lead to- heightened suspicion and a tendency to misinterpret other people's actions or intentions as being threatening
- a feeling that nowhere is safe
- obsessive behaviour patterns and difficulty with concentration
- problems with social interaction and relationships.
How would you describe the impact of feeling extremely alert and suspicious on your day-to-day functioning, possibly to the point of being almost endlessly watchful and on your guard?
Hyperarousal is a potentially exhausting state of the body's “fight-or-flight” response being stuck in a high-alert mode and is typified by a heightened startle reflex and overactive aggressive-defensive response, even in the absence of immediate danger.
Racing thoughts, also known as “brain chatter”, are fast-moving and often repetitive thought patterns that bounce around the mind uncontrollably without allowing time to fully process or complete any single thought. They can be about any subject, real or imagined and can focus on a single topic or represent multiple different strands of thought at the same time.Thought interference can be further increased by a previous conversation or speech, segment of text, piece of music, or parts thereof, looping in the brain as an unwanted and persistent underlying background “noise”.
The negative externalised distress spectrum includes a variety of disinhibited behaviours, such as- oppositional defiant disorder, or ODD, where a person might display behaviours such as
- being prone to anger and short temperedness
- often being argumentative with authority figures
- being stubborn or noncompliant, often defying or refusing to comply with instructions
- regularly annoying other people or getting easily annoyed with yourself
- becoming resentful, spiteful or vindictive, and often blaming others for your mistakes.
- conduct problems and antisocial behaviour
- displays of excessive physical aggression.
A person might also develop a habit of swearing or becoming verbally abusive.Hyperarousal can be long-lasting as a way of adapting to complex trauma or it can be a temporary state triggered by perceived threat, traumatic memories and reminders, or specific emotions.How would you describe the impact of feeling irritable or “on-edge” on your day-to-day functioning, possibly to the point of being very jumpy or very easily startled?
Paranoia is the difficult-to-prove but persistent feeling that people are “out to get you” or that you are the target of deliberate intrusive attention by others, even thought there may be little or no evidence to support such suspicions. Mild paranoid thoughts are common but more persistent or extreme paranoia can be interfere with daily functioning and social relationships.
Examples of paranoid thoughts and beliefs include- assuming that others have malicious or negative intentions, even when there is no real evidence
- believing that a secret plot or conspiracy is happening to make you look bad, harm you, or exclude you
- feeling that people, organisations, or government entities are constantly watching or tracking your movements
- harbouring a persistent belief that people are somehow trying to take advantage of you or steal your money, possessions, or ideas
- misinterpreting innocent remarks or subtle gestures as secret threats or messages designed to harm or belittle you.
Examples of paranoid behaviours include- being overly defensive and reacting to situations or criticism with hostility or aggression and a need to protect yourself
- finding it difficult to trust other people, and in particular those close to you, and obsessing over their loyalty or intentions
- firmly believing in widely disproven or unfounded conspiracy theories, such as elaborate plots by governments or secret organisations
- harbouring persistent grudges involving anger or resentment over perceived slights or harms
- keeping people at a distance or avoiding certain individuals or places altogether as a result of due to a feelings of suspicion or being targeted.
How would you describe the impact on your day-to-day functioning of unshakeable thoughts or beliefs that people are deliberately trying to sabotage you or that you are the subject of intrusive attention?
Emotional dysregulation describes difficulty managing and controlling strong feelings and emotional responses to everyday changes and events, including even the simplest of remarks or disagreements, smallest of mistakes, or lightest of touches, and often without a clear or justifiable reason. It can cause intense, prolonged, or disproportionate reactions such as excessive irritability, anger, sadness, or anxiety and be difficult for the person to return to a calm emotional state after the initial upset.
Internalised emotional dysregulation can manifest as behaviours such as rumination, social withdrawal, self-criticism, anxiety, or depression, where the distress is directed inward and may not be seem outwardly obvious and symptoms can include- frequent negative moods and crying
- refusal to engage in social activities, including a lack of interest in maintaining existing friendships or making new friends
- the loss of friends due to unpredictable or unsocial behaviour
Externalised emotional dysregulation is much more visible and behaviours can include- aspects of intermittent explosive disorder, such as
- long angry speeches or heated arguments
- easily-provoked frustration and irritation
- volatility and hair-trigger outbursts
- threats or shows of aggression, including shoving, pushing, slapping, or physical fights
- severe temper tantrums or meltdowns
- obvious physical signs of heightened anxiety, such as shaking or chest tightness.
- struggles within the home environment
- developmental delays, including substandard work or academic performance and attendance.
Uninterrupted dysregulated emotions can become increasingly crippling and potentially lead to behaviours that could be interpreted as habitually harmful, self-harmful, or reckless and self-destructive.How would you describe your ability to manage and control your feelings and emotional responses, particularly when faced with everyday changes and events?
“The self” refers to an individual's concept of identity. It develops over time and is shaped by personal experiences, social interactions, and internal thought processes.
Your self-esteem includes your sense of self-value and how you manage life challenges. Low self-esteem describes a depleted way a person feels about their inner self as a person, for example- feelings of worthlessness and a belief of being “not good enough” or deserving of affection and care
- making comparisons with others that lead to feelings of inferiority or inadequacy
- avoiding social interaction and feeling like an outsider
- unnecessarily accepting responsibility for things that go wrong and excessive apologising.
Your self-confidence controls how you see your strengths and weaknesses, how you approach challenges, set goals and how much you believe in your ability to succeed. Low self-confidence describes a lack of trust in personal abilities, capacities, and judgments, for example- having noticeably reduced motivational drive or enthusiasm to pursue goals
- avoiding new challenges as a result of a persistent conscious or subconscious fear of failure
- questioning personal abilities, decisions, and self-worth
- downplaying achievements or having difficulty accepting compliments
- being an overly harsh critic of the self.
Low self-worth can also incubate negative thoughts about the self or the world that are not always based in reality and can maintain fear or distress, for example- strong feelings of anger, fear, guilt, horror, and shame
- threat-oriented patterns of thought and behaviour, developed through experience, that lead to a heightened sense of threat and a loss of trust in others
- a sense of worthlessness or helplessness leading to a loss of confidence
- inflexible thoughts that prevent a person from processing events naturally and reduce their ability to manage their emotions.
How would you rate your combined levels of self-esteem, the overall opinion and feeling you have about yourself as a person, and self-confidence, the level of inner belief you have in your abilities, skills, and judgment?
Learned helplessness describes a mindset whereby a person internalises when they repeatedly encounter anxiety-provoking situations that they are unable to overcome such as harsh criticism or trauma. They may then start to believe that they cannot control or change things so stop trying, even if opportunities to gain control or break the negative cycle become available.
Causes can include- being subjected to training using strong negative reinforcements such as humiliation and ridiculing
- being seen as “won't do” rather than “can't do” and punished for unintended mistakes or labelled as inept, stupid, useless, etc
- regular or ongoing marginalisation, intimidation, and bullying.
Behavioural symptoms can include- giving up quickly, even when solutions are available
- applying minimal effort or initiative, believing it won't change the outcome
- delaying tasks or avoiding challenges altogether
- becoming passive or inactive in stressful situations
- having difficulty making decisions, even small ones
- not asking for help due to expecting refusal or believing it to be futile.
Emotional and cognitive symptoms can include- low self-esteem, exemplified by a core belief of being inept or worthless
- a lack of motivation as a result of a deep sense that trying is pointless
- being overly pessimistic and expecting the worst outcomes
- negative self-talk
- frustration and hopelessness through feeling powerless and overwhelmed
- increased risk of suffering from anxiety
- increased risk of developing depression.
Learned helplessness can lead to a significantly lower level of general functioning than a person might otherwise be capable of.In terms of feeling a sense of helplessness and hopelessness about changing certain parts of your current situation, how often and to what extent do you think you have become held-back by accumulated previous or ongoing criticism or belittlement from other people?
The word “victim” is used here to describe any person who has been subjected to considerable emotional or physical harm. As time passes the victim might also become a “survivor” through the emergence of a recovery process.
The theory of the “ideal victim” is seen as someone who is most easily recognised as legitimate because they conform to a set of assumed stereotypes, but this can lead to misunderstanding and exclusion, and examples include- occupational non-recognition, where an employee is not recognised as having valid claim to being a victim because of workplace expectations around being able to cope with stressful situations that fall within the remit of the job
- professional non-recognition, where formal systems such as education, healthcare, law enforcement and legal institutions fail to recognise or take the sufferer sufficiently seriously due to established or entrenched theories of victim status that do not allow for variation
- societal non-recognition, when individuals or social groups refuse to recognise someone as being worthy of victim status for reasons including
- an attitude that the lived experiences of suffering are exclusive to people from certain social classes or ethnic backgrounds
- ignorance based on the sufferer being seen as ethnically, intellectually, physically, or socially inferior and therefore not to be considered as a person of relevance
- inverted snobbery related to a sufferer's perceived success, greater wealth or higher social status.
Rate the frequency and level of disturbance to your overall emotional stability and mental wellbeing as a result of hostile attitudes by others towards what you believe to be your legitimate right to have your emotional suffering taken seriously?
Personal non-recognition of legitimacy occurs when a person sees themselves as not being worthy because they believe that they are somehow incompatible with the common image of what constitutes a victim.Rationalised non-recognition occurs when the individual feels a need to rationalise being trapped in a controlling or abusive relationship, with examples including- resorting to self-blame or creating excuses for their continued involvement
- defaulting to denial because there seems to be little or no chance of escape
- anxiety surrounding the possibility of severe consequences for them or their dependents if they try to escape.
Bereavement is the experience of losing a close person or animal, and it can trigger grief, the natural emotional and physical response to that loss. Traumatic bereavement occurs when a traumatic death disrupts the grieving process, leading to a sense of helplessness, fear, or danger, and can be linked to- loss that is sudden or unexpected and may involve circumstances that were shocking or unforeseen
- death that was a result of an accident, violence, or a natural disaster
- having been denied the opportunity to say goodbye.
There is no “normal” way or timescale to grieve and the periods of suffering can have a lasting negative impact on emotional stability and everyday functioning.How strong is your conviction that, regardless of the opinions of others, your experiences qualify you as having the right to be recognised as someone living with long-term emotional suffering?
Positive feelings such as affection, hope, interest, joy, love, pride, and serenity are associated with pleasant or desirable states. These emotions can expand our awareness, enhance resilience and foster creativity.Following disturbing and overwhelming events a person can experience a prolonged and greatly reduced ability to feel any sort of emotion in a way sufficient to bring forth from within them a meaningful reaction or response.
Emotional numbing can apply to both positive and negative emotions and symptoms can include- lessened or lack of emotional responses through the use of facial expressions
- a reduced ability to smile and laugh
- a sense of inner emptiness or flatness
- underlying feelings of irritability or nervousness
- difficulty accessing or experiencing positive emotions
- difficulty accessing or expressing feelings
- feeling distant or detached from other people
- preferring to be alone rather than engaging with others
- a loss of interest in doing things
- a loss of interest in favourite activities.
In terms of episodes of feeling emotionally numb, flat or hollowed out, how would you describe your experiences?
Being alone is the neutral physical state of being by yourself without any other person in proximity. Loneliness is a complex individually experienced and highly personal unpleasant emotional response to imagined or actual isolation and lack of social relationships.
Traumatic aloneness describes a severe form of loneliness, characterised by core emotional wounds that surface and lead to a profound sense of isolation, alienation, and disconnection from other people. It can lead to feelings of being misunderstood, unworthy, or being fundamentally different and can disrupt a person's ability to form secure relationships and trust, regardless of the availability of healthy relationships or willing company.
Symptoms can include- a persistent feeling of being alone, even when in company
- a difficult-to-ignore need to avoid social situations
- difficulty feeling positive emotions such as love and affection
- difficulty managing negative thoughts and emotions such as anxiety, sadness and depression, or fear.
- a belief in being fundamentally different to other people or not worthy of love or affection
- physical symptoms, including headaches, body aches, insomnia, or general malaise
- character conflict between a strong longing for connection coupled to an urge to be alone or push people away.
As time progresses traumatic aloneness can create a deep, lasting psychological imprint that can persist indefinitely.In terms of episodes of aloneness that included you feeling isolated, alienated, and disconnected from other people, how would you describe your experiences?
Post-traumatic growth is the positive psychological transformation that can occur after a harrowing experience alongside post-traumatic stress disorder. Whilst it does not minimise the impact of post-traumatic psychological injury on the individual, it can lead to new positive understandings of the human experience.
Key areas of change include- an increased appreciation for life
- personal relationships growing stronger through a feeling of greater connectivity to other people
- an improving and greater sense of personal strength
- an increased awareness of new possibilities
- a move to a more positive view of personal experience and acceptance that the past cannot be changed
- uplifting spiritual or philosophical change.
Allowing for any new sorts of positive thinking that you may have developed in response to an upsetting experience, how would you describe your ability to enjoy everyday life?
In the context of someone else's suffering, sympathy can be thought of as caring about it, empathy as feeling it and compassion as wanting to relieve it.
Compassion fatigue, also known as secondary or vicarious trauma, refers to the profound negative emotional and psychological impact associated with prolonged periods of repeated indirect exposure to traumatic events through dealing with individuals who are in psychological distress or have been psychologically traumatised.
Occupational areas where it can be especially common include- medical and healthcare workers such as
- doctors and nurses, in particular those who are exposed to repeated patient emergencies
- blue light responders and emergency service workers
- palliative and end-of-life care workers.
- social workers and victim support officers
- veterinarians and animal welfare workers
- members of the legal profession, particularly courtroom staff
- teaching and student affairs professionals
- formal leaders within established religions.
Non-occupational areas where it can be especially common include- the overwhelming parental stress of caring for a child that has been involved in a traumatic event, or is sick or injured
- family members and other caregivers of people who are suffering from a long-lasting health condition, particularly those that may not have a cure.
Functional symptoms include- feeling overwhelmed and exhausted by external demands
- feelings of helplessness and powerlessness when faced with suffering
- feelings of numbness and emotional detachment
- a reduced ability to feel empathy and sensitivity and emotional disconnection
- a decreased sense of purpose and a reduced level of performance, including difficulty concentrating and making decisions.
Wellbeing symptoms include- increased levels of sadness, anger and irritability
- decreasing ability to relax and increasing insomnia
- increased anxiety and physical symptoms such as headaches, nausea, upset stomach and dizziness
- increasing conflict and difficulties in personal relationships
- withdrawal and self-isolation
- self-contempt and a neglect of personal self-care
- an increase in substance use as a form of self-medication.
To what extent have your overall emotional stability and mental wellbeing been impacted by the demands placed on you to provide sympathy, empathy and compassion for people suffering from psychological distress or trauma?
Emotional dissonance is the process of managing your feelings and expressions for the benefit of a task when your true inner emotions are in conflict with the required outward emotional expression that you are expected to present.
Occupational examples include- a healthcare professional having to hide their fear or frustration and project an image of patience and empathy when dealing with a difficult patient or situation
- a law enforcement officer feeling empathy for an offender but having to appear stoic and emotionally neutral
- a retail, hospitality or customer services worker having to remain polite and helpful when dealing with a difficult customer or client despite feeling bored or upset
- a salesperson having to appear enthusiastic and optimistic about a product or service despite struggling with doubt or negativity surrounding its quality.
Non-occupational examples include- a parent having to appear strong and composed for their child even though they are overwhelmed with fear or worry
- cultural dissonance, where a person experiences conflict between differing cultural values, beliefs, or practices, impacting their sense of self and belonging in multicultural environments.
Emotional dissonance can affect members of certain groups and organisations where more extreme behaviours are expected, for example- feeling pressured to project an image of strength and fearlesness whilst inwardly experiencing anxiety, fear, or vulnerability
- having to display aggressive or callous behaviour that does not align with true inner feelings.
To what extent have your overall emotional stability and mental wellbeing been impacted by occupational requirements to present yourself publicly in a way that conflicts with your true inner feelings?
Moral injury describes the psychological pain or wounding a person suffers after they act, fail to act, or bear witness to but do not influence events that contradict their own moral beliefs and professional standards or ethics.
Non-specific examples include- being asked to act, or not act, in ways that conflict with your moral compass, training or sense of duty
- feeling that leadership provided negligent instructions or inadequate supplies but being unable to challenge it
- witnessing and being unable to prevent morally or ethically wrong behaviour by other people
- witnessing unethical behaviour or betrayal by trusted people in high-stakes situations
- being frustrated by hierarchical imbalances that prevent you from challenging an action or decision from a more senior individual
- being restricted by legal requirements which prevent the necessary course of action from being available.
Military-specific examples include- harming or killing combatants or civilians when it goes against your sense of right and wrong or during situations with unclear rules of engagement
- being unable to save a fellow service member or an injured civilian due to lack of resources or overwhelming circumstances
Healthcare-specific examples include- experiencing betrayal by leaders or colleagues regarding patient safety or well-being
- having to deal with resource limitations whilst knowing that some patients will suffer as a result
- workload being such that the quality of care provided falls well below the minimum standard that you would consider good enough.
To what extent have your overall emotional stability and mental wellbeing been impacted by personal feelings of distress, guilt, shame, disgust, or anger as a result of your required occupational role in events that you felt should or could have been managed differently?
This question is not concerned with who or what is actually responsible for any previous or active unresolved event. It explores how you are emotionally affected by the possibility of being seen as the culprit by others, whether it be publicly, privately, with or without malicious intent.
Blame-shifting within a blame culture is an environment where, when mistakes and errors happen, the primary focus is on finding any individual or group to hold responsible rather than on identifying the root cause and making the improvements necessary to prevent a recurrence.The habit of scapegoating by transferring responsibility for failure or frustration onto a seemingly vulnerable target, often as a means of deflecting guilt or blame, can exist within families, social or occupational groups, or organisations of any type and size.
How would you describe the impact of knowing or firmly believing that other people blame you for any unfortunate incident?
How would you describe the negative emotional impact of any feelings of upset, regret, or shame in relation to any unfortunate incident for which you see yourself as bearing significant responsibility?
How would you describe the impact of any difficult-to-control urges to attribute a significant part of the blame for any unfortunate incident to someone or something else?
As an emotion guilt is not a judgement but the self-directed internal feeling of distress, regret, or shame over an action, event or lack thereof which the individual, rightly or wrongly, sees themselves as bearing significant responsibility for.
How would you describe your feelings of regret or sorrow in relation to your past actions or times when you wish you had acted but did not?
A panic attack is a sudden episode of intense fear that triggers severe physical reactions, despite there being no obvious danger or apparent cause. Anxiety tends to reach its peak about ten minutes after an attack begins then usually lasts a further five to twenty minutes, although elevated distress can continue for a few hours.
A panic attack as a consequence of post-traumatic psychological injury can occur as a result of a person, place, object, memory, or discussion that triggers reminders of a harrowing experience.Symptoms are similar to those of anxiety-driven bodily stress, can be single, multiple or varying and range from mild to severe, and can include- dizzying or painful headaches
- a racing heart or chest pains
- intense breathing or shortness of breath
- abdominal pains, stomachache or an upset stomach
- uncontrollable bodily trembling or shaking
- profuse sweating, even when cold
- fatigue or weakness
- tight muscles and muscle tension
- aching in one or more groups of muscle
- fear of losing control or dying.
Panic attacks can be extremely frightening but individuals normally show some response to standard calming techniques and coping strategies.Rate the impact of panic attacks on your day-to-day life?
A meltdown as a consequence of post-traumatic psychological injury is an involuntary and uncontrolled response whereby something trips a reminder of a previous experience and difficulty with emotional processing causes a surge to such a severe level of distress as to trigger a nervous system overload.
There are three main phases to a meltdown- the rumbling phase: the initial phase after the person's sense of calm and order has been interrupted by a trigger. They may start to display signs of rapidly increasing anxiety such as
- pacing, twitching, shaking, rocking or becoming very still
- showing agitated speech patterns such as talking more quickly or more loudly than usual.
- the rage phase: the person is totally emotionally overwhelmed and excess rage, panic or despair is released as a meltdown, example behaviours being
- unrestrained crying, shouting or screaming
- uncontrolled kicking, flapping or stomping about
- repetitive movements or zoning out.
- the recovery phase: the person may be tired or sleepy, apologetic or embarrassed, deny or have no recollection of the meltdown.
Meltdowns are distinctly different from temper tantrums, which are brief purpose-driven episodes of largely deliberate extreme behaviour in response to frustration or anger at not getting or being allowed to do something. Whereas a tantrum will typically subside when the person is either rewarded or realises that their behaviour is pointless, after a meltdown individuals cannot usually respond to standard calming techniques and recovery takes an extended period of time.Rate the impact of meltdowns on your day-to-day life?
A shutdown as a consequence of post-traumatic psychological injury is a quietly-expressed involuntary and uncontrolled response that is often triggered by feeling threatened, recounting trauma, or even a perceived threat. The individual is totally emotionally overwhelmed and withdraws mentally and physically.
Example behaviours include- fleeing the trigger or completely freezing
- being unable to move or speak
- withdrawing to a quiet, dark space
- experiencing sudden exhaustion
- suffering a loss of coordination or slowed movement
- suffering a loss of communication skills.
A shutdown will continue until the person feels able to cope again and, once the initial shutdown lessens, they may show signs of exhaustion, confusion, or detachment. A shutdown can follow a meltdown if exhaustion reaches crisis level.Rate the impact of shutdowns on your day-to-day life?
A post-traumatic psychological injury can lead to a deep, persistent state of low physical and mental energy in response to the body's psychological and physiological resources being overworked for an extended period of time.
If the fatigue continues uninterrupted it will lead to burnout, a state of physical, mental, and emotional exhaustion following an extended episode of severe stress and physiological disruption and markers include- increased prevalence of exhaustion, depression and a potentially increased risk of suicidal ideation or intent
- increased levels of anxiety and stress, including suffering from headaches, gastrointestinal problems or physical pain
- increasingly disrupted diet, rest and sleep patterns
- noticeably increased sensory sensitivity
- increased difficulty with concentration, memory or making choices
- becoming increasingly withdrawn and isolated, possibly to the point of physically shutting down
- an increase in both the number of meltdowns and the time needed to recover from them.
An overwhelm “hangover” refers to the lingering physical, emotional, and psychological effects on the body's mental and physical resources and symptoms include- profound feelings of fatigue or exhaustion
- lethargy, tiredness and sleepiness
- bodily aches and pains and muscle soreness
- trembling and shaking
- headaches or brain fog
- pain in the chest region
- gastrointestinal discomfort
- a strong desire to isolate from others
- a persistent sense of discomfort or unease.
Recovery time can vary according to the individual, but often lasts anything from several hours to a few days or, in more extreme cases, over a week.How would you describe the amount of physical and emotional energy you are able to muster to tackle your everyday with interest, motivation and confidence?
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