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    Childhood Trauma Questionnaire

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    Natia Badrishvili
    This document contains a childhood trauma questionnaire with 28 questions about experiences such as physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect. Respondents rate each experience as never true, rarely true, sometimes true, often true, or very often true. Scoring instructions are provided to quantify levels of each type of abuse as none, low, moderate, or severe.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Childhood Trauma Questionnaire

    Uploaded by

    Natia Badrishvili
    7 views3 pages
    This document contains a childhood trauma questionnaire with 28 questions about experiences such as physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect. Respondents rate each experience as never true, rarely true, sometimes true, often true, or very often true. Scoring instructions are provided to quantify levels of each type of abuse as none, low, moderate, or severe.

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    This document contains a childhood trauma questionnaire with 28 questions about experiences such as physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect. Respondents rate each experience as never true, rarely true, sometimes true, often true, or very often true. Scoring instructions are provided to quantify levels of each type of abuse as none, low, moderate, or severe.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views3 pages

    Childhood Trauma Questionnaire

    Uploaded by

    Natia Badrishvili
    This document contains a childhood trauma questionnaire with 28 questions about experiences such as physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect. Respondents rate each experience as never true, rarely true, sometimes true, often true, or very often true. Scoring instructions are provided to quantify levels of each type of abuse as none, low, moderate, or severe.

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    © All Rights Reserved
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    Childhood Trauma Questionnaire

    Patient’s full name: Date accomplished:

    Name of attending professional:

    Instructions: Please rate yourself based on the options below in relation to the following possible traumatic experiences that you may
    have experienced. Take your time and be honest with your answers. This will be kept confidential.

    Never True Rarely True Sometimes


    Often True Very Often

    Item True True

    I did not have enough to eat

    I had someone to take care of me and protect


    me

    I’ve been called “stupid,” “lazy,” and/or “ugly

    My parents were too drunk/high to take care of


    me

    Someone helped me feel important

    I had to wear dirty clothes

    I felt loved

    I felt/thought that my parents wished I had never


    been born

    I got hit so hard that I had to see a doctor

    There is nothing I want to change in my family

    I’ve been hit so hard that it left bruises and


    marks

    I was punished with a belt, board, cord, or


    another hard object

    My family looked out for each other

    My family said hurtful or insulting things to me

    I was physically abused

    I had a perfect childhood.

    Bernstein D., Fink L. (1998). Childhood Trauma Questionnaire. A Retrospective Self-Report Questionnaire and Manual. San Antonio,
    The Psychological Corporation.

    PAGE 1
    Never True Rarely True Sometimes
    Often True Very Often

    Item True True

    I got hit badly and it was noticed by a teacher,


    neighbor, and/or doctor

    Someone in my family hated me

    My family felt close to each other

    Someone tried to touch me in a sexual way or


    tried to make me touch them

    Someone threatened to hurt me unless I did


    something sexual with them

    I have the best family in the world

    Someone made me try to do sexual things/watch


    sexual things

    Someone molested me

    I was emotionally abused

    Someone took me to see the doctor when I


    needed to/if I needed t

    I was sexually abused

    My family gave me strength and support.

    Scoring

    Never true =

    Rarely true =

    Sometimes true =

    Often true =

    Very often true = 5

    Some items have the inverse, though. These specific items are Items 2, 5, 7, 13, 19, 26, and 28. So, “Never true” is equal to 5, and
    “Very often true” is equal to 1.

    SCORE TALLIES

    Bernstein D., Fink L. (1998). Childhood Trauma Questionnaire. A Retrospective Self-Report Questionnaire and Manual. San Antonio,
    The Psychological Corporation.

    PAGE 2
    Score Tallies:

    Physical
    Emotional Sexual Physical Emotional
    Abuse Abuse Abuse Neglect Neglect

    9.)

    3.)

    20.)

    1.)

    *5.)

    11.)

    8.)

    21.)

    *2.)

    *7.)

    12.)

    14.)

    23.)

    4.)

    *13.)

    15.)

    18.)

    24.)

    6.)

    *19.)

    17.) 22.) 27.) *26.) *28.)

    Sum:

    The * means that the scoring is inversed for them.

    To calculate the section below, you only need to look at Items 10, 16, and 22. For each of these, if the patient answers “Very often
    true,” it’s equivalent to 1 point. If they picked other answers, then it’s equivalent to 0. The maximum score that they can get for
    Minimization/Denial is 3.

    Minimization/Denial

    10.)

    16.)

    22.)

    Sum:

    Level of Physical
    Emotional Sexual Physical Emotional
    abuse Abuse Abuse Abuse Neglect Neglect

    None
    7
    8
    5
    7
    9

    Low
    9
    12
    8
    9
    14

    Moderate
    12
    15
    12
    12
    17

    Severe 13+ 16+ 13+ 13+ 18+

    Bernstein D., Fink L. (1998). Childhood Trauma Questionnaire. A Retrospective Self-Report Questionnaire and Manual. San Antonio,
    The Psychological Corporation.
    PAGE 3

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