Trauma Inventory

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Step 1 of 48

There are 4 stages of trauma that we will discuss: Childhood, Adult, Intergenerational and Mass. We will ask questions in each of these four stages. Please answer ‘Yes’ or ‘No’.

Disclaimer: This quiz is for informational purposes only and should not be used as a diagnostic tool. It does not replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.

Takes 5-10 minutes

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First Name*

First

Email*

Childhood Trauma

(Childhood is defined as under 18 years old)

In your childhood, did you feel unsafe in your neighborhood growing up?*

Yes

In your childhood, were you bullied by a peer prior to age 18?*

Yes

In your childhood, have you seen anyone being beaten, stabbed, or shot in real life?*

Yes

In your childhood, did your caretakers fail to make you feel important or special?*

Yes

In your childhood, did your family cut sizes of meals or skip meals because there was not enough money in the budget of food for a significant period of time?*

Yes

In your childhood, did you live with anyone who was depressed or mentally ill?*

Yes

In your childhood, did you live with someone who was suicidal?*

Yes

In your childhood, did you live with anyone who was a problem drinker or alcoholic?*

Yes

In your childhood, did you live with anyone who used illegal street drugs or who abused prescription medications?*

Yes

In your childhood, did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility?*

Yes

In your childhood, were you ever in foster care?*

Yes

In your childhood, did you ever see or hear a parent, stepparent or another adult who was helping to raise you being yelled at, screamed at, sworn at, insulted or humiliated?*

Yes

In your childhood, did you ever see or hear in your home a parent, stepparent or another adult who was helping raise you being slapped, kicked, punched, or beaten up?*

Yes

In your childhood, did you ever see or hear a parent, stepparent or another adult who was helping to raise you being hit or cut with an object, such as a stick or cane, bottle, club, knife, or gun?*

Yes

In your childhood, did you ever have a parent, stepparent or another adult living in the home swear at you, insult you or put you down?*

Yes

In your childhood, did you ever have a parent, stepparent or another adult living in the home push, grab, shove or slap you?*

Yes

In your childhood, did you ever have a parent, stepparent or another adult living in the home hit you so hard you had marks or were injured?*

Yes

In your childhood, did you ever have a parent, stepparent or another adult living in the home act in a way that made you afraid that you would be physically hurt?*

Yes

In your childhood, did an adult or older relative, family friend or stranger who was at least five years older than yourself ever touch or fondle you in a sexual way or have you touch their body in a sexual way?*

Yes

In your childhood, did an adult or older relative, family friend or stranger who was at least five years older than yourself ever attempt to have or have any type of sexual intercourse, oral, anal, or vaginal with you?*

Yes

In your childhood, were your parents ever separated or divorced?*

Yes

In your childhood, were you diagnosed with a serious medical condition or life-threatening injury?*

Yes

In your childhood, did you experience significant discrimination because of your sexual identity, gender identity or gender expression?*

Yes

Which aspect of your identity (sexual orientation, gender identity, or gender expression) was the primary basis for the discrimination you experienced?*

Adult Trauma

(Adulthood is defined as 18 and over)

In your adulthood, have you ever worked in an unsupportive or toxic workplace for a significant period of time?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner who was suicidal?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner who was depressed or mentally ill?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner who was a problem drinker or alcoholic?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner who used illegal street drugs or who abused prescription medications?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner who served time or was sentenced to serve time in a prison, jail, or other correctional facility?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner where they swore at you, insulted you or put you down?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner where you were pushed, grabbed, shoved or slapped?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner where you were hit so hard you had marks or were injured?*

Yes

In your adulthood, were you in a relationship for a significant length of time with an intimate partner where you were afraid that you would be physically hurt?*

Yes

In your adulthood, were you ever sexually assaulted as an adult?*

Yes

In your adulthood, did you ever go through a separation or divorce from your spouse?*

Yes

In your adulthood, did you ever have a life-threatening injury?*

Yes

In your adulthood, have you ever experienced significant debt, such as bankruptcy, foreclosure, reliance on government assistance?*

Yes

In your adulthood, have you worked in a career or job where there is violence or exposure to death?*

Yes

In your adulthood, have you experience significant discrimination because of your sexual identity, gender identity or gender expression?*

Yes

Which aspect of your identity (sexual orientation, gender identity, or gender expression) was the primary basis for the discrimination you experienced?*

Intergenerational Trauma:

In childhood or adulthood, did you often feel that you were treated badly or unfairly because of your race or ethnicity?*

Yes

Were you, your parents or grandparents survivors of genocide?*

Yes

Were you, your parents or grandparents refugees?*

Yes

Mass Trauma:

Have you directly experienced war?*

Yes

Have you directly survived a major fatal disaster such as flood, fire, earthquake, etc?*

Yes

Were you significantly impacted by a major pandemic such as, Covid-19, SARS?*

Yes

Were you a survivor of a mass shooting?*

Yes

Phone

This field is for validation purposes and should be left unchanged.

Sources: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study Vincent J. Felitti, MD, FACP, Robert F. Anda, MD, MS, Dale Nordenberg, MD, David F. Williamson, MS, PhD, Alison M. Spitz, MS, MPH, Valerie Edwards, BA, Mary P. Koss, PhD, James S. Marks, MD, MPH

Cronholm, P. F., Forke, C. M., Wade, R., Bair-Merritt, M. H., Davis, M., Harkins-Schwarz, M., Pachter, L. M., & Fein, J. A. (2015). Adverse childhood experiences: Expanding the concept of adversity. American Journal of Preventive Medicine, 49(3), 354-361.

Wade, Jr, R., Cronholm, P. F., Fein, J. A., Forke, C. M., Davis, M. B., Harkins-Schwarz, M., … Bair-Merritt, M. H. (2016). Household and community-level Adverse Childhood Experiences and adult health outcomes in a diverse urban population. Child Abuse & Neglect, 52, 135–145.