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Brief Trauma Questionnaire (BTQ, 1999)

Please complete this field.

The following questions ask about events that may be extraordinarily stressful or disturbing for almost everyone. Please circle “Yes”
or “No” to report what has happened to you.
If you answer “Yes” for an event, please answer any additional questions that are listed on the right side of the page to report: (1)
whether you thought your life was in danger or you might be seriously injured; and (2) whether you were seriously injured.
If you answer “No” for an event, go on to the next event. 

Event

Event

1. Have you ever served in a war zone, or have you ever served in a noncombat job that exposed you to war-related casualties (for example, as a medic or on graves registration duty?)
Please select an option.
Please select an option.
Please select an option.
2. Have you ever been in a serious car accident, or a serious accident at work or somewhere else?
Please select an option.
Please select an option.
Please select an option.
3. Have you ever been in a major natural or technological disaster, such as a fire, tornado, hurricane, flood, earthquake, or chemical spill?
Please select an option.
Please select an option.
Please select an option.
4. Have you ever had a life-threatening illness such as cancer, a heart attack, leukemia, AIDS, multiple sclerosis, etc.?
Please select an option.
Please select an option.
Please select an option.
5. Before age 18, were you ever physically punished or beaten by a parent, caretaker, or teacher so that: you were very frightened; or you thought you would be injured;
Please select an option.
Please select an option.
Please select an option.
6. Not including any punishments or beatings you already reported in Question 5, have you ever been attacked, beaten, or mugged by anyone, including friends, family members or strangers?
Please select an option.
Please select an option.
Please select an option.
7. Has anyone ever made or pressured you into having some type of unwanted sexual contact? Note: By sexual contact we mean any contact between someone else and your private parts or between you and some else’s private parts
Please select an option.
Please select an option.
Please select an option.
8. Have you ever been in any other situation in which you were seriously injured, or have you ever been in any other situation in which you feared you might be seriously injured or killed?
Please select an option.
Please select an option.
Please select an option.
9. Has a close family member or friend died violently, for example, in a serious car crash, mugging, or attack?
Please select an option.
Please select an option.
Please select an option.
10. Have you ever witnessed a situation in which someone was seriously injured or killed, or have you ever witnessed a situation in which you feared someone would be seriously injured or killed? Note: Do not answer “yes” for any event you already reported in Questions 1-9
Please select an option.
Please select an option.
Please select an option.
Please complete this field.
Please complete this field.
Please complete this field.
Please complete this field.