0% found this document useful (0 votes)

30 views6 pages

Questionier 2

Uploaded by

markzugerbarg0

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

0% found this document useful (0 votes)

30 views6 pages

Questionier 2

Uploaded by

markzugerbarg0

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

You are on page 1/ 6

CONSENT FORM

We are conducting a research study to explore the relationship between PTSD and
dissociative experiences in transgender individuals. This study is led by Abdullah
Ghulam Muhammad, a student at Federal Urdu University, Abdul Haq Campus,
under the supervision of Ms. Sehrish in the Department of Psychology.

The purpose of this study is to gain a deeper understanding of how trauma and
dissociation impact the mental health of transgender individuals and to identify
ways to provide better support. You are invited to participate by completing a
questionnaire, which will take approximately 20-30 minutes. All responses will be
kept strictly confidential, securely stored, and used only for research purposes.

While the questions are designed carefully, some may bring up difficult or
uncomfortable memories. Your participation is completely voluntary, and you may
choose to withdraw at any time without any consequence.

By signing below, you confirm that you understand the purpose of the study and
agree to participate. You also consent to the use of your responses in this research,
with the assurance that all information will remain confidential.

Signature of Participant: ______________

Date: ______________
DATA COLLECTION QUESTIONIER FOR RESEARCH PURPOSE

Name: _ Profession: _

Father's Name: _ Siblings: _

Gender: _______________________

Your worst event:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

___________________________________________________

1. Sometimes I drive or ride somewhere and suddenly don’t remember part of the trip. How
often does this happen?

0% 20% 50% 80% 100%

2. Sometimes I am listening to someone but realize I didn’t hear part of what they said.
How often does this happen?

0% 20% 50% 80% 100%

3. Sometimes I find myself in a place without knowing how I got there. How often does this
happen?
0% 20% 50% 80% 100%

4. Sometimes I am wearing clothes that I don’t remember putting on. How often does this
happen?

0% 20% 50% 80% 100%

5. Sometimes I find new things among my belongings that I don’t remember buying. How
often does this happen?

0% 20% 50% 80% 100%

6. Sometimes strangers think they know me or call me by another name. How often does
this happen?

0% 20% 50% 80% 100%

7. Sometimes it feels like I’m outside my body, watching myself. How often does this
happen?

0% 20% 50% 80% 100%

8. Sometimes people tell me I don’t recognize family or friends. How often does this
happen?

0% 20% 50% 80% 100%

9. Sometimes I can’t remember important events in my life (like a wedding or graduation).

How often does this happen?

0% 20% 50% 80% 100%

10. Sometimes I am accused of lying, but I don’t think I lied. How often does this happen?

0% 20% 50% 80% 100%

11. Sometimes I look in the mirror and don’t recognize myself. How often does this happen?

0% 20% 50% 80% 100%

12. Sometimes I feel that people, objects, and the world around me aren’t real. How often
does this happen?

0% 20% 50% 80% 100%

13. Sometimes I feel like my body doesn’t belong to me. How often does this happen?

0% 20% 50% 80% 100%

14. Sometimes I remember a past event so clearly it feels like it’s happening now. How often
does this happen?

0% 20% 50% 80% 100%

15. Sometimes I’m unsure if something really happened or if I just dreamed it. How often
does this happen?

0% 20% 50% 80% 100%

16. Sometimes familiar places seem strange to me. How often does this happen?

0% 20% 50% 80% 100%

17. Sometimes I get so absorbed in a TV show or movie that I don’t notice other things
around me. How often does this happen?

0% 20% 50% 80% 100%

18. Sometimes I get so lost in a daydream that it feels real. How often does this happen?

0% 20% 50% 80% 100%

19. Sometimes I am able to ignore pain. How often does this happen?

0% 20% 50% 80% 100%

20. Sometimes I stare into space, thinking of nothing, and lose track of time. How often does
this happen?

0% 20% 50% 80% 100%

21. Sometimes I talk out loud to myself when I am alone. How often does this happen?