Q1. What things can upset, worry or disturb you very much? Do you get anxious or angry in any situations?
Q2. Are you anxious? If yes, about which matters?
Q3. Are you fearful of anything? (Animals, people, being alone, darkness, death, disease, robbers, sudden noises, thunder, the future, high places, etc.)
Q5. Have you had any period of stress in your life? Any difficult memories from childhood that still affect you?
Q6. Do you have any problems or stress in your relationships? (parents, siblings, spouse, children)
Q7. What do you do to handle stress? What really works for you?
Q8. Sensitivity – to situations, people, words?
Q9. Do you have any "fixed" habits? (cleanliness, perfectionism, alcohol, excessive exercise, checking things repeatedly, etc.)
Q10. What bodily symptoms do you develop when angry? (e.g., trembling, sweating, palpitations)
Q13. What is the greatest grief you have gone through in your life?
Q14. What are the greatest joys you have had in life?
Q15. What activities do you deeply like?
Q16. Are there any matters which you deeply dislike?
Q17. Which aspects of your mind and moods are not agreeable to you? Despite awareness, are you unable to change these?
Q18. Give a clear picture of your life situation and relationship with each family member, friend, and work associate.
Q27. How is your emotional and sexual relationship with your partner? Any problems with sexual function, craving, or performance?
Q28. How frequently do you urinate? Colour of urine? Any dribbling or other urinary/renal problems?
Q29. How is your menses? Is it regular? Any problems – pain, excess bleeding, diminished flow?