Check-list of a childhood trauma

Check-list

Childhood Traumatic
Experiences Questionnaire

The checklist is intended for adults who feel
that they were traumatized in childhood,
but find it difficult to answer how much.

Read each item and write the answer “Yes” or “No” next to it.

Before you turned 18, did your parents and other adults in your home do the following things often or very often:

Emotional Abuse:

Have you experienced insults, threats, or humiliation that left an emotional mark?
Were you afraid of being physically harmed?

Physical violence:

Were you beaten so hard that you have marks or scars?
Have you been pushed, grabbed, slapped, or had something thrown at you?

Sexual violence:

Have adults or people at least 5 years older than you ever done the following: touched or caressed you, or forced you to touch their body in a sexually suggestive manner?
Have you attempted or performed oral, anal or vaginal intercourse with you?

Family concerns:

Have you had problems getting food, clean clothes, or care from family? Have you often or very often felt hungry, had to walk around in dirty clothes, and had no one to protect you?
Or were your parents too drunk/high to take care of you or take you to the doctor when you needed it?

Family relationships:

Have you ever felt unrecognized or unloved by your family?
Have you often or very often felt that: no one in your family loves you or considers you important or special?
Or maybe your family was not accustomed to caring for each other, expressing warmth and emotional closeness towards each other, or supporting each other?

Family status:

Were your parents divorced or separated?

Violence in relationships with mother:

Was your mother or stepmother often or very often pushed, grabbed, hit, or had things thrown at her?
Or sometimes, often or very often, was she kicked, bitten, punched or hit with something very hard?
Was she either beaten repeatedly for at least several minutes, or threatened with a knife or gun?

Substance abuse:

Have you lived with someone who drank or was an alcoholic, or with someone who used drugs?

Mental health in the family:

Have family members experienced depression or mental illness? Or did one of them try to commit suicide?

Past crimes:

Has anyone living with you been arrested or in jail?

For each positive answer to 1 point, 1 point is added,

for a negative answer = 0 points.

Minimum points = 0, maximum = 18

Scores assess the total number of traumatic childhood experiences.

The higher the score, the higher the likelihood of developing mental and physical illnesses and social problems.

The life expectancy of respondents with 5 points and above is 20 years less than those with 0-5 points.

If you find yourself with more than 10 points, sign up for

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