DiLorenzo Pentagon Health Clinic
Civilian Employee Assistance Program (EAP)

The following questions are intended to help you look at whether you may be experiencing a problem with your use of alcohol. They are not designed to provide a diagnosis. For that, you need a screening by a professional who specializes in substance abuse. To obtain the greatest benefit, you should try to be completely honest.  

• 1. Do you find that alcohol has taken on a greater importance in your life or that you have begun to plan activities around the availability of alcohol? 
• 2. Do you find that alcohol has less effect on you than it did when you first started drinking?
• 3. Do you notice that you handle alcohol differently than other people? 
• 4. Do you find that you have trouble keeping the promises you make about cutting down or stopping drinking? 
• 5. Do you find that almost any occasion, happy or sad, has become an occasion for drinking? 
• 6. Do you ever feel bad or guilty about your drinking? 
• 7. Has a family member or close friend ever expressed concern to you about your drinking? 
• 8. Do you ever lie about the amount you drink or try to hide the evidence? 
• 9. Does your personality change when you are drinking or do you sometimes regret the things you’ve said or done while drinking? 
• 10. Do you ever drink in the morning, before work, or before a social occasion in order to calm your nerves? 
• 11. Have you ever awakened in the morning after drinking and discovered that you cannot remember part of the evening before? 
• 12. Has your use of alcohol ever interfered with one or more of the following areas of you life:  occupational, social, medical, or legal? 
• 13. Has a medical professional ever suggested that you should cut down or quit drinking? 
• 14. Have you even gotten a DUI, DWI, or Drunk in Public arrest? 
• 15. Have you ever been stopped by law enforcement personnel and let go, even though you were probably intoxicated? 
• 16. Have you ever had a car accident where you weren’t arrested, but had been drinking? 
• 17. Have you ever been violent when under the influence of alcohol? 
• 18. Do your hands ever shake after periods of heavy drinking?  

If you answered “yes” to any of these questions you may be experiencing a problem with alcohol. You should consider scheduling an appointment with your Employee Assistance Program to confidentially discuss the seriousness of your problem and/or any assistance that you may need. Your EAP can be reached at 703-692-8917.

Adapted from the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition.

This test was developed by National Depression Screening Day Executive Director, Douglas G. Jacobs, MD. It is not designed to provide and actual diagnosis of depression. For that, you will need a complete clinical evaluation by a mental health professional.

• 1. I am unable to do the things I used to do.
• ​2. I feel hopeless about the future.
• 3. I can’t make decisions.
• 4. I feel sluggish or restless.
• 5. I am gaining or losing weight.
• 6. I get tired for no reason.
• 7. I am sleeping too much, or too little.
• 8. I feel unhappy.
• 9. I become irritable or anxious.
• 10. I think about dying or killing myself.

If you answered “yes” to five or more of these questions, and you have felt this way every day for several weeks, there is a good chance you are suffering for depression and should see a psychiatrist or other health care professional. Please call 703-692-8917 to set up an appointment with an Employee Assistance Counselor.

If you answered “yes” to question 10, you should seek help immediately, regardless of your answer to any other questions.

Adapted from the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition

The following questions were developed for National Anxiety Disorders Screening Day by the National Mental Illness Screening Project. They are not intended to provide an actual diagnosis. For that, you will need a complete evaluation by a mental health professional.

• 1. Do you ever experience a sudden, unexplained attack of intense fear, anxiety or panic for no apparent reason?
• 2. Have you been afraid of not being able to get help or not being able escape in certain situations, like being on a bridge, in a crowded store or in similar situations?
• 3. Do you find it difficult to control your worrying?
• 4. Do you spend more time than is necessary doing things over and over again, such as washing your hands, checking things, or counting things?
• 5. Do you either avoid or feel very uncomfortable in situations involving people, such as parties, weddings, dating, dances or other social events?
• 6. Have you ever had an extremely frightening, traumatic or horrible experience like being the victim of a violent crime, seriously injured in a car accident, sexually assaulted, or seeing someone injured or killed?

If you answered “yes” to any of these questions, you should see a mental heath professional to determine whether you are suffering from an anxiety disorder. You can schedule an appointment with an Employee Assistance Counselor by calling 703-692-8917.

Adapted from the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition.

The following questions are intended to help you look at whether you may have an eating disorder. They are not designed to provide a diagnosis. For that, you need a screening with a mental health professional. To obtain the greatest benefit from this questionnaire, be as honest as possible.

• 1. Do you have an intense fear of gaining weight or becoming fat?
• 2. Do you spend excessive amounts of time thinking about food?
• 3. Are you over-concerned with body shape or weight?
• 4. Do you engage in binge eating (rapid consumption of a large amount of food in a discrete period of time)?
• 5. Have you ever felt a lack of control over your eating behavior during a binge?
• 6. Have you ever felt guilty after a binge?
• 7. Do you ever self-induce vomiting after meals?
• 8. Do you use laxatives, diuretics, strict dieting, fasting, or excessive exercise as a means of maintaining or losing weight?

A “yes” response to any of the above questions could indicate an eating disorder. For a more thorough assessment and evaluation, you should see a mental health professional who specializes in eating disorders. To learn more about eating disorders or to talk with a counselor about your responses to this questionnaire, please call your Employee Assistance Program at 703-692-8917.

Adapted from the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition

The following questions are intended to help you look at whether you may have post traumatic stress disorder. They are not designed to provide a diagnosis. For that, you need a screening with a mental health professional. To obtain the greatest benefit from this questionnaire, be as honest as possible. 

PTSD Checklist – Civilian Version (PCL-C)

Instructions: Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and put an “X” in the box to indicate how much you have been bothered by that problem in the last month. If your answers fall mostly in the 3 to 5 range, this could be an indicator of a bigger issue. Please see a mental health or medical professional to discuss your results.

PCL-M for DSM-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD – Behavioral Science Division

This is a Government document in the public domain