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Easy Diagnostic System for DSM Quiz

Welcome to your Easy Diagnostic System for DSM Quiz

This survey will assess the kinds of problems you've been having and will
help your therapist perform a thorough diagnostic evaluation. It takes about 30 to 45
minutes to complete and focuses on common problems, such as:

 Difficulties in your work or personal relationships
 Mood problems such as depression
 Anxiety, such as shyness, panic, chronic worrying, and phobias
 Reactions to stressful or traumatic events
 Pain or other physical symptoms
 Addictions to gambling, drugs, or alcohol
 Eating problems, such as overeating, anorexia nervosa, or purging (bulimia)

If you have any questions about any of the symptoms you've been experiencing, be
sure to ask your therapist. This should be an educational process, and there shouldn't
be anything mysterious or secretive about it.

Please add up your score on each test after you complete it. If this
seems too difficult, don't worry about it. Your therapist can help you with that part.

Name
1. What is your gender?
2. What is your age?
3. What is your marital status?
4. What is your racial background? (Please check the one that applies best)
5. What is your highest education level reached?
6. What is your family's annual income?
7. Please write a brief explanation of why you're seeking therapy at this time:
9. Approximately how many times have you been hospitalized for psychiatric problems?
10. Are you currently receiving disability?
11. Are you currently seeking disability?
12. Are you currently involved in any lawsuits or legal disputes?
13. In order to overcome feelings of depression and anxiety, if a therapist or trusted friend suggested it, I'd be willing to try new ways of relating to other people.
14. In order to overcome feelings of depression and anxiety, if a therapist or trusted friend suggested it, I'd be willing to get started on a task I've been avoiding or putting off.
15. In order to overcome feelings of depression and anxiety, if a therapist or trusted friend suggested it, I'd be willing to make a plan for solving the problems in my life.
16. In order to overcome feelings of depression and anxiety, if a therapist or trusted friend suggested it, I'd be willing to face a problem I've been avoiding.
17.  In order to overcome feelings of depression and anxiety, if a therapist or trusted friend suggested it, I'd be willing to confront my fears, even if it makes me very anxious.
18. Have you had any problems at school?
19. Have you had any problems with your work or career?
20. Have you had any problems or conflicts in your relationships with your child or parents?
21. Have you had any problems or conflicts in your relationships with a brother or sister?
22. Have you had any problems or conflicts in your relationships with your spouse or partner?
23. Have you had any abuse or violence in your relationship with a spouse or partner?
24. Have you had any abuse, violence, or neglect in your childhood?
25. Are you struggling because of the death of a loved one?
The following questions relate to your relationship to one person. Please put his or her name below.
26. How satisfied or dissatisfied to do feel with the communication and openness in the relationship with this person?
27. How satisfied or dissatisfied to do feel resolving conflicts and arguments in the relationship with this person?
28. How satisfied or dissatisfied do you feel in the degree of affection and caring in the relationship with this person?
29. How satisfied or dissatisfied do you feel in your intimacy and closeness with this person?
30. What is your overall satisfaction in the relationship with this person?
31. Indicate how frustrated you've been feeling with yourself recently.
32. Indicate how annoyed you've been feeling with yourself recently.
33. Indicate how irritated you've been feeling with yourself recently.
34 . Indicate how frustrated you've been feeling toward others recently.
35. Indicate how annoyed you've been feeling toward others recently.
36. Indicate how irritated you've been feeling toward others recently.
37. I've had thoughts or fantasies of hurting people.
38. I've had the urge to do something harmful or violent.
39. I intend to do something harmful or violent.
40. How sad or down in the dumps are you feeling right now, at this very moment?
41. How discouraged or hopeless are you feeling right now, at this very moment?
42. How low are your feelings of self-esteem, inferiority or worthlessness right now, at this very moment?
43. Are you having a loss of motivation to do things right now, at this very moment?
44. Are you having a loss of pleasure or satisfaction in life right now, at this very moment?
45. I've felt depressed or unhappy on most days for the past two years.
46. I've felt sad, blue, or down most of the time for the past two years.
47. Was there ever a time in your life when you felt sad, blue, or depressed almost every day for a period of at least two years?
48. I've been feeling down or depressed nearly every day for the past two weeks.
49. I've lost interest in nearly all pleasurable or rewarding activities during the past two weeks.
50. I’ve been feeling hopeless.
51. Feelings of depression have been distressing or upsetting to me.
52. Feelings of depression have been causing problems in my work, relationships, or activities.
53. At times, I've had thoughts or fantasies of killing myself
54. At times, I've had the urge to commit suicide.
55. Was there ever a time in your life when you felt sad, blue, or depressed every day for at least two weeks?
56. During the past two weeks, have you had a poor appetite?
57. During the past two weeks, have you been overeating?
58. During the past two weeks, have you had trouble sleeping?
59. During the past two weeks, have been sleeping too much?
60. During the past two weeks, have you had trouble concentrating or making decisions?
61. I feel excited and enthusiastic about practically everything.
62. I feel far happier and more cheerful than usual.
63. I've been feeling irritable at times.
64. I've been feeling angry at times.
65. I've been feeling extremely worthwhile.
66. I've had tremendously high self-esteem.
67. My mind has been flooded with creative, exciting ideas.
68. Almost everything seems to capture my attention.
69. I've had enormous energy.
70. During the past month, have you felt intensely euphoric or excessively irritable all day long, every day, for at least four days in a row?
71. During the past month, have you felt intensely euphoric or excessively irritable all day long, every day, for at least one week?
72. Were you taking drugs or alcohol when you had these kinds of feelings?
73. Have you felt intensely euphoric or excessively irritable at any time during your life?
74. Did you feel intensely euphoric or excessively irritable all day long, every day, for at least four days in a row?
75. Did you feel intensely euphoric or excessively irritable all day long, every day, for at least a week?
76. Were you taking drugs or alcohol when you had these symptoms?
77. How anxious have you been feeling recently?
78. How nervous have you been feeling recently?
79. How worried have you been feeling recently?
80. How frightened or apprehensive have you been feeling recently?
81. How tense or on edge have you been feeling recently?
82. How strong is the skipping, racing, or pounding of the heart when you are feeling worried, anxious or panicky?
83. How strong is your trembling or shaking when you are feeling worried, anxious or panicky?
84. How strong is your sweating, chills, or hot flushes when you are feeling worried, anxious or panicky?
85. Do you feel short of breath or difficulty breathing when you are feeling worried, anxious or panicky?
86. Do you feel dizzy, lightheaded, or off-balance when you are feeling worried, anxious or panicky?
87. I worry about things a lot.
88. I tend to worry all day long.
89. I've been worrying about things more days than not for the past six months.
90. The worrying is upsetting to me.
91. The worrying makes it hard for me to relax and enjoy life.
92. I have sudden attacks of terror or panic that come from out of the blue.
93. During the panic attacks I feel like I'm about to die, faint, go crazy, or lose control.
94. During the panic attacks, I have intense physical symptoms, such as dizziness, tingling, racing heart, tight muscles, or feeling short of breath.
95. The panic attacks become absolutely terrifying within ten minutes or less.
96. The panic attacks are upsetting or cause problems in my life.
97. During panic attacks, I feel like I'm about to faint, pass out, or have a stroke?
98. During panic attacks, I feel like I'm about to have a heart attack or die.
99. During panic attacks, I feel like I'm about to smother or suffocate.
100. During panic attacks, I feel like I'm about to crack up, go crazy, or lose my mind.
101. During panic attacks, I feel like I'm about to lose control.
102. Indicate how many panic attacks you've had in the past month
103. I'm afraid of being away from home alone.
104. I'm afraid I'll panic if I'm away from home alone.
105. My fear of being away from home alone is upsetting to me.
106. My fear of being away from home alone causes problems in my life.
107. My fear of being away from home alone limits my activities.
108. How strongly do you fear being in a crowd or standing in line?
109. How strongly do you fear busy stores, restaurants, or theaters?
110. How strongly do you fear bridges, elevators, parking garages, churches, auditoriums, or stadiums?
111. How strongly do you fear open places like a field or street?
112. How strongly do you fear trains, buses, subways, cars, or boats?
Frankie Gonzalez

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