1. How often do you feel inferior to most of the people you know?
2. How often do you have the feeling that there is nothing you can do well?
3. When in a group of people, do you have trouble thinking of the right things to talk about?
4. How often do you feel worried or bothered about what other people think of you?
5. In turning in a major assignment such as a term paper, how often do you feel you did an excellent job on it?
6. How confident are you that others see you as being physically appealing?
7. Do you ever think that you are a worthless individual?
8. How much do you worry about how well you get along with other people?
9. When you make an embarrassing mistake or have done something that makes you look foolish, how long does it take you to get over it?
10. When you have to read an essay and understand it for a class assignment, how worried or concerned do you feel about it?
11. Compared with classmates, how often do you feel you must study more than they do to get the same grades?
12. Have you ever thought of yourself as physically uncoordinated?
13. How confident do you feel that someday the people you know will look up to you and respect you?
14. How often do you worry about criticisms that might be made of your work by your teacher or employer?
15. Do you often feel uncomfortable meeting new people?
16. When you have to write an argument to convince your teacher, who may disagree with your ideas, how concerned or worried do you feel about it?
17. Have you ever felt ashamed of your physique or figure?
18. Have you ever felt inferior to most other people in athletic ability?
19. Do you ever feel so discouraged with yourself that you wonder whether you are a worthwhile person?
20. Do you ever feel afraid or anxious when you are going into a room by yourself where other people have already gathered and are talking?
21. How often do you worry whether other people like to be with you?
22. How often do you have trouble expressing your ideas when you have to put them into writing as an assignment?
23. Do you often feel that most of your friends or peers are more physically attractive than yourself?
24. When involved in sports requiring physical coordination, are you often concerned that you will not do well?
25. How often do you dislike yourself?
26. How often do you feel self-conscious?
27. How often are you troubled with shyness?
28. How often do you have trouble understanding things you read for class assignments?
29. Do you often wish or fantasize that you were better-looking?
30. Have you ever thought that you lacked the ability to be a good dancer or do well at recreational activities involving coordination?
31. In general, how confident do you feel about your abilities?
32. How much do you worry about whether other people regard you as a success or failure in your job or at school?
33. When you think that some of the people you meet might have an unfavorable opinion of you, how concerned or worried do you feel about it?
34. How often do you imagine that you have less scholastic ability than your classmates?
35. Have you ever been concerned or worried about your ability to attract members of the opposite sex?
36. When trying to do well at a sport and you know other people are watching, how rattled or flustered do you get?