Brief Symptoms Inventory.docx

Brief Symptom Inventory BSA Here is the list of problems that people sometimes experience. Read each one and put a check on the box that described HOW MUCH THAT PROBLEM HAS DISTRESSED OR BOTHERED YOU.

0 = Not at all 3 = Quite a bit

1 = A little bit 4 = Extremely

2 = Moderately R = Refused

How much you were distressed by?

0

1

2

3

1.

Nervousness or shakiness inside

2.

Faintness or dizziness

3.

The idea that someone else can control your thoughts

4.

Feeling others are to blame for most of your troubles

X

5.

Trouble remembering things

X

6.

Feeling easily annoyed or irritated

X

7.

Pains in the heart or chest

8.

Feeling afraid in open spaces

9.

Thoughts of ending your life

X X X

X X X

10. Feeling that most people cannot be trusted 11. Poor appetite

X X

12. Suddenly scared for no reason

X

13. Temper outbursts that you could not control

X

14. Feeling lonely even when you are with people

X

15. Feeling blocked in getting things done

X

16. Feeling lonely

X

17. Feeling blue

X

18. Feeling no interest in things

X

19. Feeling fearful

X

20. Your feelings being easily hurt

X

21. Feeling that people are unfriendly or dislike you

X

22. Feeling inferior to others

X

23. Nausea or upset stomach

4

X

24. Feeling that you are watched or talked about by others

X

25. Trouble falling asleep

X

26. Having to check and double check what you do

X

27. Difficulty making decisions

X

28. Feeling afraid to travel on buses, subways, or trains

X

29. Trouble getting your breath 30. Hot or cold spells

X X X

31. Having to avoid certain things, places, or activities because they frighten you 32. Your mind going blank 33. Numbness or tingling in parts of your body 34. The idea that you should be punished for your sins

X X X

R

35. Feeling hopeless about the future

X

36. Trouble concentrating

X

37. Feeling weak in parts of your body

X

38. Feeling tense or keyed up

X

39. Thoughts of death or dying

X

40. Having urges to beat, injure, or harm someone

X

41. Having urges to break or smash things

X

42. Feeling very self-conscious with others

X

43. Feeling uneasy in crowds

X

44. Never feeling close to another person

X

45. Spells of terror or panic

X

46. Getting into frequent arguments

X

47. Feeling nervous when you are left alone

X

48. Others not giving you proper credit for your achievements

X

49. Feeling so restless you couldn’t sit still 50. Feelings of worthlessness

X X

51. Feeling that people will take advantage of you if you let them

X

52. Feeling of guilt

X

53. The idea that something is wrong with your mind

X