All the therapists listed on the PTSDhelp directory have agreed to provide their professional services for no more than £35.00 Per individual therapy session to UK service personnel serving or retired who are affected by PTSD.
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Diagnostic form
Gender Male Female Age Name
Please circle only one Single Married Separated Divorced
Length of service —––––––––– Service arm Army Navy RAF other
Tick the appropriate boxes relevant to your feelings:
Sleep problems including nightmares and waking early.
Flashbacks and replays which you are unable to switch off.
Impaired memory, forgetfulness, inability to recall names, facts and dates that are well known to you.
Impaired concentration.
Impaired learning ability (eg through poor memory and inability to concentrate).
Hyper vigilance (feels like but is not paranoia).
Exaggerated startle response.
Irritability, sudden intense anger, occasional violent outbursts.
Panic attacks.
Hypersensitivity, whereby every remark is perceived as critical.
Obsessiveness - the experience takes over your life, you can't get it out of your mind.
Joint and muscle pains which have no obvious cause.
Feelings of nervousness, anxiety.
Reactive depression (not endogenous depression).
Excessive levels of shame, embarrassment.
Survivor guilt for having survived when others perished or for not having done more to help or save others.
A feeling of having been given a second chance at life.
Undue fear.
Low self-esteem and shattered self-confidence.
Emotional numbness, anhedonia (inability to feel love or joy).
Feelings of detachment.
Avoidance of anything that reminds you of the experience.
Physical and mental paralysis at any reminder of the experience.
The information below will make it easier for your therapist to understand your unique personal situation
Please use the printable version by clicking here PRINTABLE VERSION