Childhood Trauma Questionnaire (Pennebaker, 1988)

1. Prior to the age of 17, did you experience a death of a very close friend or family member?________
If yes, how old were you?_________
If yes, how traumatic was this? (using a 7-point scale, where 1 = not at all traumatic, 4 = somewhat traumatic, 7 = extremely traumatic)_________
If yes, how much did you confide in others about this traumatic experience at the time? (1 = not at all, 7 = a great deal)_________

2. Prior to the age of 17, was there a major upheaval between your parents (such as divorce, separation)?_________
If yes, how old were you?________
If yes, how traumatic was this? (where 7 = extremely traumatic)______
If yes, how much did you confide in others? (7 = a great deal)_______

3. Prior to the age of 17, did you have a traumatic sexual experience (raped, molested, etc.)?_______
If yes, how old were you?_______
If yes, how traumatic was this? (7 = extremely traumatic)_______
If yes, how much did you confide in others? (7 = a great deal)_______

4. Prior to the age of 17, were you the victim of violence (child abuse, mugged or assaulted — other than sexual)?______
If yes, how old were you?______
If yes, how traumatic was this? (7 = extremely traumatic)_______
If yes, how much did you confide in others? (7 = a great deal)_______

5. Prior to the age of 17, were you extremely ill or injured?______
If yes, how old were you?________
If yes, how traumatic was this? (7 = extremely traumatic)_______
If yes, how much did you confide in others? (7 = a great deal)_______

6. Prior to the age of 17, did you experience any other major upheaval that you think may have shaped your life or personality significantly?_______
If yes, how old were you?_______
If yes, what was the event?_______________________________________
If yes, how traumatic was this? (7 = extremely traumatic)_______
If yes, how much did you confide in others? (7 = a great deal)_______

Recent Traumatic Events Scale
For the following questions, again answer each item that is relevant and again be as honest as you can. Each question refers to any event that you may have experienced within the last 3 years.

1. Within the last 3 years, did you experience a death of a very close friend or family member?______
If yes, how traumatic was this? (1 = not at all traumatic, 7 = extremely traumatic)_______
If yes, how much did you confide in others about the experience at the time? (1 = not at all, 7 = a great deal)______

2. Within the last 3 years, was there a major upheaval between you and your spouse (such as divorce, separation)?______
If yes, how traumatic was this?______
If yes, how much did you confide in others?_____

3. Within the last 3 years, did you have a traumatic sexual experience (raped, molested, etc.)?_____
If yes, how traumatic was this?_____
If yes, how much did you confide in others?_____

4. Within the last 3 years, were you the victim of violence (other than sexual)?______
If yes, how traumatic was this?_____
If yes, how much did you confide in others?______

5. Within the last 3 years, were you extremely ill or injured?_____
If yes, how traumatic was this?_____
If yes, how much did you confide in others?_____

6. Within the last 3 years, has there been a major change in the kind of work you do (e.g., a new job, promotion, demotion, lateral transfer)?_____
If yes, how traumatic was this?_____
If yes, how much did you confide in others?_____

7. Within the last 3 years, did you experience any other major upheaval that you think may have shaped your life or personality significantly?_____
If yes, what was the event?_______________________________________
If yes, how traumatic was this?_____
If yes, how much did you confide in others?_____

Source:  Pennebaker, J.W. & Susman, J.R. (1988). Disclosure of traumas and psychosomatic processes. Social Science and Medicine, 26, 327-332.

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