1. Identity
I often have no sense of who I am, especially when I am with other people
I am sometimes confused about who I am, especially when I am with other people
I have a stable sense of who I am
My sense of who I am is generally too fixed and restricted (e.g., in relation to work or to another person)
My sense of who I am is overly restricted and unchangeable no matter the circumstances
2. Self-worth
Most of the time I feel worthless, which affects how I relate to other people
I often have a hard time feeling good about myself, which sometimes affects how I relate to other people
I usually feel good about myself
I often feel I am better than others, which affects how I relate to other people
I feel superior to others, which affects how I relate to other people
3. Self-perception
I have a good sense of my strengths and weaknesses
I have few weaknesses or limitations
I have no weaknesses or limitations
4. Goals
I am rarely able to set and follow goals
I sometimes find it hard to set and follow goals
I have no problem setting and following realistic goals
I sometimes find it hard to change my goals even when they will be too difficult to achieve
I regularly find it hard to change my goals even when they will be nearly impossible to achieve
5. Interest in relationships
I have no interest in being with others and do anything to avoid them
I have little interest in being with others and therefore avoid them
I have a good balance of being by myself and being with others
I sometimes feel upset when not around others
I often feel upset when not around others
6. Perspective-taking
I never think about other people's thoughts and feelings
I often do not think about other people's thoughts and feelings
I can easily relate to other people's thoughts and feelings
I often think too much about how others think and feel
I always think too much into how others think and feel
7. Mutuality in relationships
People always complain that I am too selfish in relationships
People have sometimes complained that I am too selfish in relationships
I am able to establish and maintain close and mutually satisfying relationships
I am sometimes unable to end relationships, even when they are harmful to me
I am rarely able to end relationships, even when they are harmful to me
8. Disagreement management
I often get into disagreements with others that cause serious relationship problems
I sometimes get into disagreements with others that cause relationship problems
I am able to manage disagreements in relationships in a cooperative manner
I often avoid disagreements by giving into others, even if I will be worse off
I avoid disagreements and conflicts with others at any cost
9. Emotional control and expression
I often cannot control my emotions, which causes serious problems with others
I sometimes have trouble controlling my emotions, which causes some problems with others
I am generally able to control and express my emotions in an appropriate way
People sometimes complain that I don't express emotions
People often complain that I never express emotions at all
10. Behavioral control
I often act so rashly or impulsively that it causes serious problems
I sometimes act on impulse without considering the consequences, which causes problems
I am generally able to be spontaneous while keeping appropriate control of my actions
I am sometimes so controlled in my actions that I don't get the same out of life as others do
I am often so over-controlled in my actions that I hardly get anything out of life
11. Experience of reality during stress
My experience of situations is usually accurate when feeling stressed out
My experience of situations is somewhat distorted when feeling stressed out (e.g., expecting the worst to happen, feeling rejected when criticized by others)
I sometimes lose touch with what is real when feeling stressed out (e.g., suspicious, feeling disconnected from reality, or things around me are like in a dream)
I often lose touch with reality when feeling stressed out (e.g., extreme suspiciousness, seeing or hearing things that other people can't, having out-of-body experiences)
12. Harm to self
13. Harm to others (intentional or unintentional)
14. In thinking about your answers to the above, how much do they cause problems in important areas of your life (e.g., personal, family, social, education, work)?
The presented answer sheet is not an original form and is not intended for printing or use as a handout.