Answer these questions Yes or No. Base your answers
on the past 6 months.
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1. Do you frequently neglect your diet? |
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O Yes |
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O No |
|
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2. Do you usually try to do everything yourself? |
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O Yes |
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O No |
|
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3. Do you blow up easily? |
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O Yes |
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O No |
|
| |
4. Do you seek unrealistic goals? |
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O Yes |
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O No |
|
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5. Are you irritated or moody more than in the past? |
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O Yes |
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O No |
|
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6. Do you frequently make a "big deal" of everything? |
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O Yes |
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O No |
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7. Do you often complain that you are disorganized? |
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O Yes |
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O No |
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8. Do you typically keep everything inside? |
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O Yes |
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O No |
|
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9. Have you been neglecting exercise? |
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O Yes |
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O No |
|
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10. Do you lack supportive relationships? |
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O Yes |
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O No |
|
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11. Are you often tired? Not getting enough sleep? |
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O Yes |
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O No |
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12. Have you noticed an increase or decrease in your appetite? |
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O Yes |
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O No |
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13. Do you ignore stress symptoms? |
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O Yes |
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O No |
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14. Do you procrastinate and put things off until later? |
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O Yes |
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O No |
|
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15. Have you been feeling depressed? Lethargic? |
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O Yes |
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O No |
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16. Are you too busy to include time for relaxation daily? |
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O Yes |
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O No |
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17. Do you feel as if you are racing through the day? |
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O Yes |
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O No |
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18. Do you feel unable to cope with all you have to do? |
|
O Yes |
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O No |
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