Form1 | Tanu Choksi

INSTRUCTIONS:

There are 175 statements in total. If you find a statement applicable to you from the age of your adolescence (which is 15 years), then mark it true. If it is applicable sometimes or not at all applicable to you then mark it as false. It’s mandatory to respond to all the statements.

Name

Age

Date of Birth

Gender

Female Male Other

1. Lately, my strength seems to be draining out of me, even in the morning.

TRUE FALSE

2. I think highly of rules because they are a good guide to follow.

TRUE FALSE

3. I enjoy doing so many different things that I can’t make up my mind what to do first.

TRUE FALSE

4. I feel weak and tired much of the time.

TRUE FALSE

5. I know I am a superior person, so I don’t care what people think.

TRUE FALSE

6. People never give me enough recognition for the things I’ve done.

TRUE FALSE

7. If my family puts pressure on me, I’m likely to feel angry and resist doing what they want.

TRUE FALSE

8. People make fun of me behind my back, talking about the way I act or look.

TRUE FALSE

9. I often criticize people strongly if they annoy me.

TRUE FALSE

10. What few feelings I seem to have I rarely show to the outside world.

TRUE FALSE

11. I have a hard time keeping my balance when walking

TRUE FALSE

12. I show my feelings easily and quickly.

TRUE FALSE

13. My drug habits have often gotten me into a great deal of trouble in the past.

TRUE FALSE

14. Sometimes I can be pretty rough and mean in my relations with my family.

TRUE FALSE

15. Things that are going well today won’t last very long.

TRUE FALSE

16. I am a very agreeable and submissive person.

TRUE FALSE

17. As a teenager, I got into lots of trouble for bad school behaviour.

TRUE FALSE

18. I’m afraid to get really close to another person because it may end up with me being ridiculed or shamed

TRUE FALSE

19. I seem to choose friends who end up mistreating me

TRUE FALSE

20. I’ve had sad thoughts much of my life since I was a child.

TRUE FALSE

21. I like to flirt with members of the opposite sex.

TRUE FALSE

22. I’m a very erratic person, changing my mind and feelings all the time.

TRUE FALSE

23. Drinking alcohol has never caused me any real problems in my work.

TRUE FALSE

24. I began to feel like a failure some years ago.

TRUE FALSE

25. I feel guilty much of the time for no reason that I know.

TRUE FALSE

26. Other people envy my abilities.

TRUE FALSE

27. When I have a choice, I prefer to do things alone.

TRUE FALSE

28. I think it is necessary to place strict controls on the behaviour of members of my family.

TRUE FALSE

29. People usually think if me as a reserved and serious-minded person.

TRUE FALSE

30. Lately I have begun to feel like smashing things.

TRUE FALSE

31. I think I’m a special person who deserves special attention from others.

TRUE FALSE

32. I am always looking to make new friends and meet new people.

TRUE FALSE

33. If someone criticized me for making a mistake, I would quickly point out some of that person’s mistake.

TRUE FALSE

34. Lately, I have gone all to pieces.

TRUE FALSE

35. I often give up doing things because I’m afraid I won’t do them well.

TRUE FALSE

36. I often let my angry feelings out and then feel terribly guilty about it.

TRUE FALSE

37. I often lose my ability to feel any sensations in parts of my body.

TRUE FALSE

38. I do what I want without worrying about its effects on others.

TRUE FALSE

39. Taking so-called illegal drugs may be unwise, but in the past I found I needed them.

TRUE FALSE

40. I guess I’m a fearful and inhibited person.

TRUE FALSE

41. I have done number of stupid things on impulse that ended up causing me great trouble.

TRUE FALSE

42. I never forgive an insult or forgive an embarrassment that someone caused me.

TRUE FALSE

43. I often feel sad or tense right after something good has happened to me.

TRUE FALSE

44. I feel terribly sad and depressed much of the time now.

TRUE FALSE

45. I always try hard to please others even when I dislike them.

TRUE FALSE

46. I’ve always had less interest in sex than most people do.

TRUE FALSE

47. I tend to always blame myself when things go wrong.

TRUE FALSE

48. A long time ago I decided its best to have little to do with people.

TRUE FALSE

49. Since I was a child I have always had to watch out for people who were trying to cheat me.

TRUE FALSE

50. I strongly resent “big shots” who always think they can do things better than I can.

TRUE FALSE

51. When things get boring I like to stir up some excitement.

TRUE FALSE

52. I have an alcohol problem that has made difficulties for me and my family.

TRUE FALSE

53. Punishment never stopped me from doing what I wanted.

TRUE FALSE

54. There are many times when for no reason I feel very cheerful and full of excitement.

TRUE FALSE

55. In recent weeks I feel worn out for no special reason.

TRUE FALSE

56. For some time now I’ve been feeling very guilty because I can't do things right anymore.

TRUE FALSE

57. I think I am a very sociable and out going person.

TRUE FALSE

58. I’ve become very jumpy in the last few weeks.

TRUE FALSE

59. I keep very close track of my money so I am prepared if a need comes up.

TRUE FALSE

60. I just haven’t had the luck in life the others have had.

TRUE FALSE

61. Ideas keep turning over and over in my mind and they won’t go away.

TRUE FALSE

62. I’ve become quite discouraged about life in the past year or two.

TRUE FALSE

63. Many people have been spying into my private life for years.

TRUE FALSE

64. I don’t know why but I sometimes say cruel things just to make others unhappy.

TRUE FALSE

65. I flew across the Atlantic thirty times last year.

TRUE FALSE

66. My habit of abusing, drugs has caused me to miss work in the past.

TRUE FALSE

67. I have many ideas that are ahead of the times

TRUE FALSE

68. Lately I have to think things over and over again for no good reason.

TRUE FALSE

69. I avoid most social situations because I expect people to criticize or reject me.

TRUE FALSE

70. I often think that I do not deserve the good things that happen to me

TRUE FALSE

71. When I’m alone I often feel the strong presence of someone nearby who can’t be seen.

TRUE FALSE

72. I feel pretty aimless and don’t know where I’m going in life.

TRUE FALSE

73. I often allow others to make important decisions for me.

TRUE FALSE

74. I can’t seem to sleep, and wake up jus as tired as when I went to bed.

TRUE FALSE

75. Lately, I’ve been sweating a great deal and feel very tense.

TRUE FALSE

76. I keep having strange thoughts that I wish I could get rid of.

TRUE FALSE

77. I have a great deal of trouble trying to control and impulse to drink to excess.

TRUE FALSE

78. Even when I’m awake, I don’t seem to notice people who are near to me.

TRUE FALSE

79. I’m often cross and grouchy.

TRUE FALSE

80. It is very easy for me to make friends.

TRUE FALSE

81. I’m ashamed of some of the abuses I suffered when I was young.

TRUE FALSE

82. I always make sure that my work is well planned and organized.

TRUE FALSE

83. My moods seem to change a great deal from one day to the next.

TRUE FALSE

84. I’m too unsure of myself to risk trying something new.

TRUE FALSE

86. For some time now I’ve been feeling sad and blue and can’t seem to snap out of it.

TRUE FALSE

87. I often get angry with people who do things slowly.

TRUE FALSE

88. I never sit on the sidelines when I’m at a party.

TRUE FALSE

89. I watch my family closely so I’ll know who can and who cannot be trusted.

TRUE FALSE

90. I sometimes get confused and feel upset when people are kind to me.

TRUE FALSE

91. My use of so-called illegal drugs has led to family arguments.

TRUE FALSE

92. I’m alone most of the time and I prefer it that way.

TRUE FALSE

93. There are members of my family who say I’m selfish and think one only of myself.

TRUE FALSE

94. People can easily change my ideas, even if I thought my mind was made up.

TRUE FALSE

95. I often make people angry by bossing them.

TRUE FALSE

96. People have said in the past that I became too interested and too excited about too many things.

TRUE FALSE

97. I believe in saying, “early to bed and early to rise”

TRUE FALSE

98. My feelings toward important people in my life often swing from loving them to hating them.

TRUE FALSE

99. In social groups I’m almost always very self-conscious and tense.

TRUE FALSE

100. I guess I’m no different from my parents in becoming somewhat of an alcoholic.

TRUE FALSE

101. I guess I do not take many of my family responsibilities as seriously as I should.

TRUE FALSE

102. Ever since I was a child, I’ve been losing touch with the real world.

TRUE FALSE

103. Sneaky people often try to get the credit for things I have done or thought of.

TRUE FALSE

104. I can’t experience much pleasure because I don’t feel I deserve it.

TRUE FALSE

105. I have little desire for close friends.

TRUE FALSE

106. I’ve had many periods in my life when I was so cheerful and used up so much energy that I fell into a low mood.

TRUE FALSE

107. I’ve completely lost my appetite and have trouble sleeping and most nights.

TRUE FALSE

108. I worry a great deal about being left alone and having to take care of myself.

TRUE FALSE

109. The memory of a very upsetting experience in my past keeps coming back to haunt my thoughts.

TRUE FALSE

110. I was on the front cover of several magazines last year.

TRUE FALSE

111. I seem to have lost interest in most things that I used to find pleasurable, such as sex.

TRUE FALSE

112. I’ve been downhearted and sad much of my life since I was quite young.

TRUE FALSE

113. I’ve gotten into trouble with the law a couple of times

TRUE FALSE

114. A good way to avoid mistakes is to have a routine for doing things.

TRUE FALSE

115. Other people often blame me for things I didn’t do.

TRUE FALSE

116. I’ve had to be really rough with some people to keep them in line.

TRUE FALSE

117. People think I sometimes talk about strange or different things than they do.

TRUE FALSE

118. There have been times when I couldn’t get through the day without some street drugs.

TRUE FALSE

119. People are trying to make me believe that I’m crazy.

TRUE FALSE

120. I’ll do something desperate to prevent a person I love from abandoning me.

TRUE FALSE

121. I go on eating binges a couple of times a week.

TRUE FALSE

122. I seem to make a mess of good opportunities that come my way.

TRUE FALSE

123. I’ve always had a hard time stopping myself from feeling blue and unhappy.

TRUE FALSE

124. When I’m alone and away from home, I often begin to feel tense and panicky.

TRUE FALSE

125. People sometimes get annoyed with me because they say I talk too much or too fast for them.

TRUE FALSE

126. Most successful people today have been either lucky or dishonest.

TRUE FALSE

127. I won’t get involved with people unless I’m sure they’ll like me.

TRUE FALSE

129. Years later I still have nightmares about an event that was a real threat to my life.

TRUE FALSE

130. I don’t have the energy to concentrate on my everyday responsibilities anymore.

TRUE FALSE

131. Drinking alcohol helps when I’m feeling down.

TRUE FALSE

132. I hate to think about some of the ways I was abused as a child.

TRUE FALSE

133. Even in good times, I’ve always been afraid that things would soon go bad.

TRUE FALSE

134. I sometimes feel crazy-like or unreal when things start to go badly in my life.

TRUE FALSE

135. Being alone, without the help of someone close to depend upon really frightens me.

TRUE FALSE

136. I know I’ve spent more money than should buying illegal drugs.

TRUE FALSE

137. I always see to it that my work is finished before taking time out for leisure activities.

TRUE FALSE

138. I can tell that people are talking about me when I pass by them.

TRUE FALSE

139. I’m very good at making up excuses when I get into trouble.

TRUE FALSE

140. I feel I’m being plotted against.

TRUE FALSE

140. I feel I’m being plotted against.

TRUE FALSE

141. I feel that most people think poorly of me.

TRUE FALSE

142. I frequently feel there’s nothing inside me, like I’m empty and hollow.

TRUE FALSE

143. I sometimes force myself to vomit after eating.

TRUE FALSE

144. I guess I go out of my way to encourage people, to admire the things I say or do.

TRUE FALSE

145. I spend my life worrying over one thing or another.

TRUE FALSE

146. I always wonder what the real reason is when someone is acting especially nice to me.

TRUE FALSE

147. There are certain thoughts that keep coming back again and again in my mind.

TRUE FALSE

148. Few things in life give me pleasure.

TRUE FALSE

149. I feel shaky and feel difficulty falling asleep because painful memories of my past keep running through my mind.

TRUE FALSE

150. Looking ahead as each day begins makes me feel terribly depressed.

TRUE FALSE

151. I’ve never been able to shake the feeling that I’m worthless to others.

TRUE FALSE

152. I have a drinking problem that I’ve tried unsuccessfully to end.

TRUE FALSE

153. Someone has been trying to control my mind.

TRUE FALSE

154. I have tried to commit suicide.

TRUE FALSE

155. I’m willing to starve myself to be even thinner than I am.

TRUE FALSE

156. I don’t understand why some people smile at me.

TRUE FALSE

157. I’ve not seen a car in the last ten years.

TRUE FALSE

158. I get very tense with people I don’t know well because they may want to harm me.

TRUE FALSE

159. Someone would have to be pretty exceptional to understand my special abilities.

TRUE FALSE

160. My current life is still upset by flashbacks of something terrible that happened to me.

TRUE FALSE

161. I seem to create situations with others in which I get hurt or feel rejected.

TRUE FALSE

162. I often get lost in my thoughts and forget what is going on around me.

TRUE FALSE

163. People say I’m a thin person, but I feel that my thighs and backside are much too big.

TRUE FALSE

164. There are terrible events from my past that come back repeatedly to haunt my thoughts and dreams.

TRUE FALSE

165. Other than my family, I have no close friends.

TRUE FALSE

166. I act quickly much of the time and don’t think things through as I should.

TRUE FALSE

167. I take great care to keep my life a private matter so no one can take advantage of me.

TRUE FALSE

168. I very often hear things so well that it bothers me.

TRUE FALSE

169. I’m always willing to give in others in a disagreement because I fear their anger or rejection.

TRUE FALSE

170. I repeat certain behaviors again and again, sometimes to reduce my anxiety and sometimes to stop something bad from happening.

TRUE FALSE

171. I have given serious thought recently to doing away with myself.

TRUE FALSE

172. People tell me that I’m a very proper and moral person.

TRUE FALSE

173. I still feel terrified when I think of a traumatic experience I had years ago.

TRUE FALSE

174. Although I’m afraid to make friendships, I wish I had more than I do.

TRUE FALSE

175. There are people who are supposed to be my friends who would like to do me harm.

TRUE FALSE

TANU CHOKSI