1.
Do you ever feel sad?
(please tick)
Never Sometimes
Often Nearly
always
If you ticked
"never", please go to question 2
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
2.
Do you ever feel as if
people seem to drop hints about you or say things with a double meaning?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 3
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
3.
Do you ever feel that you are not a very animated person?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 4
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
4.
Do you ever feel that you are not much of a talker when you are
conversing with other people?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 5
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
5.
Do you ever feel as if
things in magazines or on TV were written especially for you?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 6
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
6.
Do you ever feel as if
some people are not what they seem to be?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 7
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
7.
Do you ever feel as if
you are being persecuted in some way?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 8
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
8.
Do you ever feel that you experience few or no emotions at
important events?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 9
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
9.
Do you ever feel pessimistic about everything?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 10
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
10.
Do you ever feel as if there is a conspiracy against you?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 11
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
11.
Do you ever feel as if you are destined to be someone very
important?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 12
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
12.
Do you ever feel as if there is no future for you?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 13
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
13.
Do you ever feel that you are a very special or unusual person?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 14
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
14.
Do you ever feel as if you do not want to live anymore?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 15
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
15.
Do you ever think that people can communicate telepathically?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 16
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
16.
Do you ever feel that you have no interest to be with other
people?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 17
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
17.
Do you ever feel as if electrical devices such as computers can
influence the way you think?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 18
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
18.
Do you ever feel that you are lacking in motivation to do
things?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 19
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
19.
Do you ever cry about nothing?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 20
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
20.
Do you believe in the power of witchcraft, voodoo or the occult?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 21
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
21.
Do you ever feel that you are lacking in energy?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 22
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
22.
Do you ever feel that people look at you oddly because of your
appearance?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 23
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
23.
Do you ever feel that your mind is empty?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 24
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
24.
Do you ever feel as if the thoughts in your head are being taken
away from you?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 25
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
25.
Do you ever feel that you are spending all your days doing
nothing?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 26
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
26.
Do you ever feel as if the thoughts in your head are not your
own?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 27
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
27.
Do you ever feel that your feelings are lacking in intensity?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 28
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
28.
Have your thoughts ever been so vivid that you were worried
other people would hear them?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 29
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
29.
Do you ever feel that you are lacking in spontaneity?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 30
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
30.
Do you ever hear your own thoughts being echoed back to you?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 31
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
31.
Do you ever feel as if you are under the control of some force
or power other than yourself?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 32
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
32.
Do you ever feel that your emotions are blunted?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 33
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
33.
Do you ever hear voices when you are alone?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 34
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
34.
Do you ever hear voices talking to each other when you are
alone?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 35
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
35.
Do you ever feel that you are neglecting your appearance or
personal hygiene?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 36
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
36.
Do you ever feel that you can never get things done?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 37
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
37.
Do you ever feel that you have only few hobbies or interests?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 38
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
38.
Do you ever feel guilty?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 39
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
39.
Do you ever feel like a failure?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", please go to question 40
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
40.
Do you ever feel tense?
(please tick)
Never Sometimes Often Nearly
always
If you ticked
"never", you are now ready
If you ticked
"sometimes" , "often" or "nearly always" please
indicate how distressed you are by this experience:
(please tick)
Not distressed A bit distressed Quite
distressed Very distressed
41. Do you ever feel as if a double has taken
the place of a family member, friend or acquaintance?
(please
tick)
Never Sometimes Often Nearly
always
If
you ticked "never", you are now ready
If
you ticked "sometimes" , "often" or "nearly
always" please indicate how distressed you are by this experience:
(please
tick)
Not
distressed A bit distressed Quite
distressed Very distressed
42. Do you ever see objects, people or animals
that other people cannot see?
(please
tick)
Never Sometimes Often Nearly
always
If
you ticked "never", you are now ready
If
you ticked "sometimes" , "often" or "nearly
always" please indicate how distressed you are by this experience:
(please
tick)
Not
distressed A bit distressed Quite
distressed Very distressed