Chapter 11 Early Trauma Inventory Self Report Survey

11.1 Background

The Early Trauma Inventory Self Report Survey asked the following questions:

  1. Were you every exposed to a life-threatening natural disaster?
  2. Were you involved in a serious accident?
  3. Did you ever suffer a serious personal injury or illness?
  4. Did you ever experience the death or serious illness of a parent or primary caretaker?
  5. Did you experience the divorce or separation of your parents?
  6. Did you experience the death or serious injury of a sibling?
  7. Did you experience the death or serious injury of a friend?
  8. Did you ever witness violence towards others, including family members?
  9. Did anyone in your family ever suffer from mental health or psychiatric illness or have a “breakdown”?
  10. Did your parent or primary caretaker have a problem with alcoholism or drug or drug abuse?
  11. Did you ever see someone murdered?
  12. Were you ever slapped in the face with an open hand?
  13. Were you every burned with hot water, a cigarette or something else?
  14. Were you ever punhed or kicked?
  15. Were you ever hit with an object that was thrown at you?
  16. Were you ever pushed or shoved?
  17. Were you often put down or ridiculed?
  18. Were you often ignored or made to feel that you didn’t count?
  19. Were you often told that you were no good?
  20. Most of the time were you treated in a cold, uncaring way or made to feel like you were not loved?
  21. Did your parents or caretakers often fail to understand you or your needs?
  22. Were you ever touched in an intimate or private part of your body (e.g. breast, thighs, genitals) in a way that surprised you or made you feel uncomfortable?
  23. Did you ever experience someone rubbing their genitals against you?
  24. Were you ever forced or coerced to touch another person in an intimate or private part of their body?
  25. Did anyone ever have genital sex with you against your will?
  26. Were you ever forced or coerced to perform oral sex on someone against your will?
  27. Were you ever forced to kiss someone in a sexual rather than affectionate way?
  28. Did you ever experience emotions of intense fear, horror, or helplessness?
  29. Did you ever feel out-of-your-body or as if you were in a dream?

More information on the Early Trauma Inventory Self Report Survey (ETISR-SF): http://onlinelibrary.wiley.com/doi/10.1002/1520-6394(2000)12:1%3C1::AID-DA1%3E3.0.CO;2-W/full