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 |
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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. Are you living in constant fear that you can't keep up with expenses? |
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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 unable to cope with all you have to do? |
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O Yes |
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O No |
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