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 |