Jenison Psychological Services

"The Place To Go For Understanding"

	Self-Help Screening
The following screening is provided for your information only. No record will be kept and you are not required to identify yourself. Answer Yes or No to each of the following questions. Base your answers on what has happened in the last six months. When you have answered each question, click the Submit button found at the bottom of the page. You will receive your confidential results.

	Yes	No
1. I blame myself for a lot of things
2. I've been feeling hopeless about the future
3. I've lost interest in many things
4. I feel worthless
5. I've thought about or want to commit suicide
6. Most days I feel very nervous
7. I worry about a lot of things
8. I can't stop worrying
9. I'm easily annoyed or irritated
10. Worry has changed my sleeping habits
11. I have powerful and ongoing fears about social situations involving unfamiliar people
12. I get very concerned when I'm in a place where escape might be difficult such as in a crowd, on a bridge of an enclosed room
13. I often have shortness of breath and a racing heart for no apparent reason
14. I have an unreasonable fear of an object of situation such as flying, heights, animals, blood or something else
15. I am unable to travel alone or without a companion
16. I am terrified about being overweight
17. I give a lot of time and thought to food
18. I've gone on eating binges where I couldn't stop
19. I often vomit after eating
20. I am more than 100 pounds over-weight
21. I've witnessed a life-threatening event that caused intense fear, helplessness or horror
22. I have repeated thoughts or dreams about a life-threatening event
23. I fear a life-threatening event will occur again
24. I have intense physical or emotional distress when I am exposed to things that remind me of a life threatening event
25. I have unwanted ideas, images or impulses that seem silly, nasty or horrible
26. I worry a lot about dirt, germs or chemicals
27. I often worry that something bad will happen because I forget to do something
28. I worry I'll speak or act aggressively when I really don't want to
29. There are things I must do or think excessively in order to feel comfortable
30. I wash myself or things around me much more than most people do
31. I have to check things over and over again or repeat them many times to be sure they are done properly
32. I have an intense fear of social situations where people might judge me
33. I'm afraid that I will be humiliated by what I do
34. I worry that people will notice that I'm blushing, sweating or show other signs of anxiety
35. I think my fears are unreasonable, but I can't stop feeling this way
36. I avoid being around people as much as I can