Each life event is assigned a value in arbitrary “life changing units” chosen to reflect the relative amount of stress the event causes in the population studied. Stress is cumulative, so to estimate the total stress you are experiencing, add up the values corresponding to the events that have occurred in your life over the past year.

1. 

I generally feel anxious in new social situations where I may not know what is expected of me.

2. 

I find it difficult to hear criticism about myself.

3. 

I fear being made to look like a fool.

4. 

I tend to magnify my mistakes and minimize my successes.

5. 

I am very critical of myself and others.

6. 

I have periods in which I feel devastated and/or depressed.

7. 

I am anxious and fearful much of the time.

8. 

When someone mistreats me I think that I must have done something to deserve it.

9. 

I have difficulty knowing who to trust and when to trust.

10. 

I often feel like I don’t know the right thing to do or say.

11. 

I am very concerned about my appearance.

12. 

I am easily embarrassed.

13. 

I think others are very focused on – and critical of – what I say and do.

14. 

I fear making a mistake which others might see.

15. 

I often feel depressed about things I’ve said and done, or things I failed to say or do.

16. 

I have avoided making changes in my life because I was fearful of making a mistake or failing.

17. 

I often get defensive and strike back when I perceive I am being criticized.

18. 

I have not accomplished what I am capable of due to fear and avoidance.

19. 

I tend to let fear and anxiety control many of my decisions.

20. 

I tend to think negatively much of the time.

21. 

I have found it difficult to perform adequately or without embarrassment when involved in sex.

22. 

I’m one of the following: The person who reveals too much personal information about myself or the person who seldom reveals person information.

23. 

I often get so anxious that I don’t know what to say

24. 

I often procrastinate.

25. 

I try to avoid conflict and confrontation.

26. 

I’ve been told I’m too sensitive.

27. 

I felt inferior or inadequate as a child.

28. 

I tend to think that I have higher standards than others.

29. 

I often feel like I don’t know what is expected of me.

30. 

I often compare myself to others.

31. 

I frequently think negative thoughts about myself and others.

32. 

I often feel that others mistreat me and or take advantage of me.

33. 

At night, I frequently review my day, analyzing what I said and did or what others said and did to me that day.

34. 

I often make decisions on the basis of what would please others rather than what I want or without even considering what I want.

35. 

I often think that others don’t respect me.

36. 

I often refrain from sharing my opinions, my ideas, and my feelings in groups.

37. 

I sometimes lie when I feel that the truth would result in criticism or rejection.

38. 

I’m fearful that I will say or do something that will make me look stupid or incompetent.

39. 

I do not set goals for the future.

40. 

I am easily discouraged.

41. 

I am not very aware of my feelings.

42. 

I grew up in a dysfunctional home.

43. 

I think life is harder for me than for most other people.

44. 

I often avoid situations where I think I will be uncomfortable.

45. 

I tend to be a perfectionist, needing to look perfect and to do things perfectly.

46. 

I feel too embarrassed to eat out alone or attend movies and other activities by myself.

47. 

I often find myself angry or hurt by the behavior and words of others.

48. 

At times I get so anxious or upset that I experience most of the following: heart racing or pounding, sweating, tearfulness, blushing, difficulty swallowing or lump in my throat, shaking, poor concentration, dizziness, nausea or diarrhea, butterflies.

49. 

I am very fearful of criticism, disapproval or rejection.

50. 

I rely on the opinion of others to make decisions.


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(817) 946-1620 | carrie@carrienet.com | Licensed Online Therapy and Counseling

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