| not at all | a little bit | moderate | quite a bit | extremely |
---|
1. Headaches |
1. Headaches | | | | | |
2. Nervousness or shakiness inside |
2. Nervousness or shakiness inside | | | | | |
3. Repeated unpleasant thoughts that won’t leave your mind |
3. Repeated unpleasant thoughts that won’t leave your mind | | | | | |
4. Faintness or dizziness |
4. Faintness or dizziness | | | | | |
5. Loss of sexual interest or pleasure |
5. Loss of sexual interest or pleasure | | | | | |
6. Feeling critical of others |
6. Feeling critical of others | | | | | |
7. The idea that someone else can control your thoughts |
7. The idea that someone else can control your thoughts | | | | | |
8. Feeling others are to blame for most of your troubles |
8. Feeling others are to blame for most of your troubles | | | | | |
9. Trouble remembering things |
9. Trouble remembering things | | | | | |
10. Worried about sloppiness or carelessness |
10. Worried about sloppiness or carelessness | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
11. Feeling easily annoyed or irritated |
11. Feeling easily annoyed or irritated | | | | | |
12. Pains in heart or chest |
12. Pains in heart or chest | | | | | |
13. Feeling afraid in open spaces or in streets |
13. Feeling afraid in open spaces or in streets | | | | | |
14. Feeling low in energy or slowed down |
14. Feeling low in energy or slowed down | | | | | |
15. Thoughts of ending your life |
15. Thoughts of ending your life | | | | | |
16. Hearing voices that other people do not hear |
16. Hearing voices that other people do not hear | | | | | |
17. Trembling |
17. Trembling | | | | | |
18. Feeling that most people cannot be trusted |
18. Feeling that most people cannot be trusted | | | | | |
19. Poor appetite |
19. Poor appetite | | | | | |
20. Crying easily |
20. Crying easily | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
21. Feeling shy and uneasy with the opposite sex |
21. Feeling shy and uneasy with the opposite sex | | | | | |
22. Feeling of being trapped or caught |
22. Feeling of being trapped or caught | | | | | |
23. Suddenly scared for no reason |
23. Suddenly scared for no reason | | | | | |
24. Temper outbursts that you could not control |
24. Temper outbursts that you could not control | | | | | |
25. Feeling afraid to go out of your house alone |
25. Feeling afraid to go out of your house alone | | | | | |
26. Blaming yourself for things |
26. Blaming yourself for things | | | | | |
27. Pains in lower back |
27. Pains in lower back | | | | | |
28. Feeling blocked in getting things done |
28. Feeling blocked in getting things done | | | | | |
29. Feeling lonely |
29. Feeling lonely | | | | | |
30. Feeling blue |
30. Feeling blue | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
31. Worrying too much about things |
31. Worrying too much about things | | | | | |
32. Feeling no interest in things |
32. Feeling no interest in things | | | | | |
33. Feeling fearful |
33. Feeling fearful | | | | | |
34. Your feelings being easily hurt |
34. Your feelings being easily hurt | | | | | |
35. Other people being aware of your private thoughts |
35. Other people being aware of your private thoughts | | | | | |
36. Feeling others do not understand you or are unsympathetic |
36. Feeling others do not understand you or are unsympathetic | | | | | |
37. Feeling that people are unfriendly or dislike you |
37. Feeling that people are unfriendly or dislike you | | | | | |
38. Having to do things very slowly to insure correctness |
38. Having to do things very slowly to insure correctness | | | | | |
39. Heart pounding or racing |
39. Heart pounding or racing | | | | | |
40. Nausea or upset stomach |
40. Nausea or upset stomach | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
41. Feeling inferior to others |
41. Feeling inferior to others | | | | | |
42. Soreness of your muscles |
42. Soreness of your muscles | | | | | |
43. Feeling that you are watched or talked about by others |
43. Feeling that you are watched or talked about by others | | | | | |
44. Trouble falling sleep |
44. Trouble falling sleep | | | | | |
45. Having to check and double-check what you do |
45. Having to check and double-check what you do | | | | | |
46. Difficulty making decisions |
46. Difficulty making decisions | | | | | |
47. Feeling afraid to travel on buses, subways or trains |
47. Feeling afraid to travel on buses, subways or trains | | | | | |
48. Trouble getting your breath |
48. Trouble getting your breath | | | | | |
49. Hot or cold spells |
49. Hot or cold spells | | | | | |
50. Having to avoid certain things, places or activities, because they frighten you |
50. Having to avoid certain things, places or activities, because they frighten you | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
51. Your mind going blank |
51. Your mind going blank | | | | | |
52. Numbness or tingling in parts of your body |
52. Numbness or tingling in parts of your body | | | | | |
53. A lump in your throat |
53. A lump in your throat | | | | | |
54. Feeling hopeless about the future |
54. Feeling hopeless about the future | | | | | |
55. Trouble concentrating |
55. Trouble concentrating | | | | | |
56. Feeling weak in parts of your body |
56. Feeling weak in parts of your body | | | | | |
57. Feeling tense or keyed up |
57. Feeling tense or keyed up | | | | | |
58. Heavy feelings in your arms or legs |
58. Heavy feelings in your arms or legs | | | | | |
59. Thoughts of death or dying |
59. Thoughts of death or dying | | | | | |
60. Overeating |
60. Overeating | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
61. Feeling uneasy when people are watching or talking about you |
61. Feeling uneasy when people are watching or talking about you | | | | | |
62. Having thoughts that are not your own |
62. Having thoughts that are not your own | | | | | |
63. Having urges to beat, injure or harm someone |
63. Having urges to beat, injure or harm someone | | | | | |
64. Waking up early in the morning |
64. Waking up early in the morning | | | | | |
65. Having to repeat the same actions such as touching, counting, washing |
65. Having to repeat the same actions such as touching, counting, washing | | | | | |
66. Sleep that is restless or disturbed |
66. Sleep that is restless or disturbed | | | | | |
67. Having urges to break or smash things |
67. Having urges to break or smash things | | | | | |
68. Having ideas or beliefs that others do not share |
68. Having ideas or beliefs that others do not share | | | | | |
69. Feeling very self-conscious with others |
69. Feeling very self-conscious with others | | | | | |
70. Feeling uneasy in crowds such as shopping or at movies |
70. Feeling uneasy in crowds such as shopping or at movies | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
71. Feeling everything is an effort |
71. Feeling everything is an effort | | | | | |
72. Spells of terror or panic |
72. Spells of terror or panic | | | | | |
73. Feeling uncomfortable about eating or drinking in public |
73. Feeling uncomfortable about eating or drinking in public | | | | | |
74. Getting into frequent arguments |
74. Getting into frequent arguments | | | | | |
75. Feeling nervous when you are left alone |
75. Feeling nervous when you are left alone | | | | | |
76. Others not giving you proper credit for achievements |
76. Others not giving you proper credit for achievements | | | | | |
77. Feeling alone even when you are with people |
77. Feeling alone even when you are with people | | | | | |
78. Feeling so restless you couldn’t sit still |
78. Feeling so restless you couldn’t sit still | | | | | |
79. Feeling of worthlessness |
79. Feeling of worthlessness | | | | | |
80. Feeling that familiar things are strange or unreal |
80. Feeling that familiar things are strange or unreal | | | | | |
|
| not at all | a little bit | moderate | quite a bit | extremely |
---|
81. Shouting or throwing things |
81. Shouting or throwing things | | | | | |
82. Feeling afraid you will faint in public |
82. Feeling afraid you will faint in public | | | | | |
83. Feeling that people will take advantage of you if you let them |
83. Feeling that people will take advantage of you if you let them | | | | | |
84. Having thoughts about sex that bother you a lot |
84. Having thoughts about sex that bother you a lot | | | | | |
85. The idea that you should be punished for your sins |
85. The idea that you should be punished for your sins | | | | | |
86. Feeling pushed to get things done |
86. Feeling pushed to get things done | | | | | |
87. The idea that something serious is wrong with your body |
87. The idea that something serious is wrong with your body | | | | | |
88. Never feeling close to another person |
88. Never feeling close to another person | | | | | |
89. Feelings of guilt |
89. Feelings of guilt | | | | | |
90. The idea that something is wrong with your mind |
90. The idea that something is wrong with your mind | | | | | |