Over the last 2 weeks, how often have you been bothered by the following problems?
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling/staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself
Trouble concentrating on things
Moving/speaking slowly or being fidgety/restless
Thoughts that you would be better off dead or of hurting yourself
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen
Please rate how much the following problems have bothered you during the past week. Mark only one box for each problem, and be sure to answer all items.
I am afraid of people in authority
I am bothered by blushing in front of people
Parties and social events scare me
I avoid talking to people I don't know
Being criticized scares me a lot
Fear of embarrassment causes me to avoid doing things or speaking to people
Sweating in front of people causes me distress
I avoid going to parties
I avoid activities in which I am the center of attention
Talking to strangers scares me
I avoid having to give speeches
I would do anything to avoid being criticized
Heart palpitations bother me when I am around people
I am afraid of doing things when people might be watching
Being embarrassed or looking stupid are among my worst fears
I avoid speaking to anyone in authority
Trembling or shaking in front of others is distressing to me
Please answer the questions based on your experiences over the past 6 months:
1. Trouble wrapping up final details of a project
2. Difficulty organizing tasks requiring organization
3. Problems remembering appointments/obligations
4. Avoid/delay starting tasks requiring lots of thought
5. Fidget/squirm when sitting for long periods
6. Feel overly active/driven by a motor
7. Make careless mistakes on boring/difficult projects
8. Difficulty maintaining attention during repetitive work
9. Difficulty concentrating on direct conversations
10. Misplace/have difficulty finding things
11. Easily distracted by activity/noise around you
12. Leave seat when expected to remain seated
13. Feel restless or fidgety
14. Difficulty unwinding/relaxing during downtime
15. Talk too much in social situations
16. Finish others' sentences during conversations
17. Difficulty waiting your turn
18. Interrupt others when they're busy
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:
Had nightmares about it or thought about it when you didn't want to?
Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
Were constantly on guard, watchful, or easily startled?
Felt numb or detached from others, activities, or your surroundings?
1. How much more or less do you feel you worry about your weight and body shape than other people your age?
2. How afraid are you of gaining 3 pounds?
3. When was the last time you went on a diet?
4. Compared to other things in your life, how important is your weight to you?
5. Do you ever feel fat?
6. In the past 3 months, how many times have you had a sense of loss of control AND eaten an unusually large amount of food?
9. In the past 3 months, how many times have you done any of the following to control your weight and shape?
Made yourself throw-up?
Used diuretics or laxatives?
Exercised excessively?
Fasted?
10. Do you consume a small amount of food (less than 1200 calories/day) regularly to influence your shape or weight?
11. Do you struggle with a lack of interest in eating or food?
12. Do you avoid certain or many foods because of texture, consistency, temperature, or smell?
13. Do you avoid certain or many foods because of fear of negative consequences like choking or vomiting?
14. Have you experienced significant weight loss (or are at a low weight) but are not overly concerned with your body size or shape?
15. Are you currently in treatment for an eating disorder?
Please check the box next to the answer that comes closest to how you have felt IN THE PAST 7 DAYS:
1. I have been able to laugh and see the funny side of things
2. I have looked forward with enjoyment to things
3. I have blamed myself unnecessarily when things went wrong
4. I have been anxious or worried for no good reason
5. I have felt scared or panicky for no very good reason
6. Things have been getting on top of me
7. I have been so unhappy that I have had difficulty sleeping
8. I have felt sad or miserable
9. I have been so unhappy that I have been crying
10. The thought of harming myself has occurred to me