1. Symptoms you are currently experiencing that have been ruled out as physical problems by your physician.
- Do you get headaches?
- Do you have muscle pain?
- Do you experience rapid heartbeat?
- Do you get stomach aches?
- Do you grind your teeth at night?
- Do you have problems falling asleep or staying asleep?
- Do you lack energy or motivation?
2. Present emotional state.
- Are you easily agitated?
- Do you have difficulty finding enjoyment in activities that once were pleasurable?
- Do you have difficulty getting along with others?
- Do you find yourself crying more lately?
- Do you find yourself with no discernible emotion?
- Do you find yourself disconnected from others?
- Do you have difficulty thinking clearly?
- Do you have difficulty concentrating?
- Are you worried much of the time?
- Are you afraid to stand up for yourself?
- Do you have difficulty giving yourself credit when you have done something well?
- Do you find that your feelings are hurt often and that you do not have the ability to soothe yourself?
- Do you have difficulty trusting others?
- Do you have problems forgiving others?
- Do you have problems forgiving yourself?
- Do you have low self esteem?
- Do you have difficulty making and keeping friendships?
- Do you have difficulty making and keeping intimate relationships?
- Do you sense that something is wrong but have difficulty identifying problems?
3. Childhood history
- Were you physically abused by your parents or others?
- Were you neglected by your parents or others close to you?
- Were you emotionally abused by your parents or others?
- Were you sexually abused as a child?
- Did your parents play with you when you were a child?
- What were your parents' expectations of you as a child and as a teenager?
- What were your grades like in school?
- How did your parents discipline you?
- How did your parents deal with their failures?
- Did your parents praise you for doing well?
- What was the most positive event of your childhood?
- What was the most upsetting/traumatic event of your childhood?
- How did this affect you as a child?
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