ITEM

RESPONSE

1.

It is normal to be unsure that you are safe from being harmed or hurt.

0 1 2 3 4 5

Never Always

2.

It is easy for people to hurt others with unfair criticism or blame.

0 1 2 3 4 5

Never Always

3.

I look for all the compliments and praise I am due

0 1 2 3 4 5

Never Always

4.

I often say so when it feels like life is unfair or things are not going my way or in my favor

0 1 2 3 4 5

Never Always

5.

More than a few times a day I feel frustrated or upset

0 1 2 3 4 5

Never Always

6.

It is very uncomfortable whenever others find fault with one’s appearance or image

0 1 2 3 4 5

Never Always

7.

It is difficult to wait for people or things

0 1 2 3 4 5

Never Always

8.

I probably speak or act in haste at times. 


0 1 2 3 4 5

Never Always

9.

I often regret things soon after I say or do them.

0 1 2 3 4 5

Never Always

10.

Some of my statements could be (or have been) described as sarcastic humor. 


0 1 2 3 4 5

Never Always

11.

I may sometimes react very strongly or “lose it”

0 1 2 3 4 5

Never Always

12.

Many situations are difficult in a relationship (whether at work, socially, in the family and/or in romantic situations)

0 1 2 3 4 5

Never Always

13.

The things that make a person very defensive or feel offended are always around you

0 1 2 3 4 5

Never Always

14.

It is always very important to get as much information as there is. 


0 1 2 3 4 5

Never Always

15.

Order, tidiness and cleanliness are very important

0 1 2 3 4 5

Never Always

16.

I have a definite liking or dislike for certain textures, colors, patterns and/or motion

0 1 2 3 4 5

Never Always

17.

It might seem to others that my behavior is opposite to or inconsistent with other behaviors in similar situations

0 1 2 3 4 5

Never Always

18.

Most of the time I take almost all statements and actions of others seriously or “as is”

0 1 2 3 4 5

Never Always

19.

Being on time and using time effectively are always very important

0 1 2 3 4 5

Never Always

20.

It is seldom necessary to disclose all of one’s options

0 1 2 3 4 5

Never Always

21.

I worry often about many things. 


0 1 2 3 4 5

Never Always

22.

“Do things my way” could well be my motto, because that always feels better

0 1 2 3 4 5

Never Always

23.

Very often my mind is full of thoughts that come up again and again.

0 1 2 3 4 5

Never Always

24.

At least one of my parents (the person who raised me) may be described as “a worrier”

0 1 2 3 4 5

Never Always

25.

At least one of my parents (the person who raised me) had emotional problems when I was growing up

0 1 2 3 4 5

Never Always

26.

I have suffered from the effects of trauma or a difficult emotional life for at least two years

0 1 2 3 4 5

Never Always

27.

I and/or one parent experienced a dangerous or very threatening personal, political and/or military event/s for an extended period

0 1 2 3 4 5

Never Always

28.

I have been/am being bullied

0 1 2 3 4 5

Never Always

29.

I and/or one parent has suffered a serious illness

0 1 2 3 4 5

Never Always