1 – I often feel this way
2 – I sometimes feel this way
3 – I rarely feel this way
4 – I never feel this way
¹
1
2
3
4
1
I am unhappy doing so many things alone.
2
I have nobody to talk to.
3
I cannot tolerate being so alone.
4
I lack companionship.
5
I feel as if nobody really understands me.
6
I find myself waiting for people to call or write.
7
There is no one I can turn to.
8
I am no longer close to anyone.
9
My interests and ideas are not shared by those around me.
10
I feel left out.
11
I feel completely alone.
12
I am unable to reach out and communicate with those around me.
13
My social relationships are superficial.
14
I feel starved for company.
15
No one really knows me well.
16
I feel isolated from others.
17
I am unhappy being so withdrawn.
18
It is difficult for me to make friends.
19
I feel shut out and excluded by others.
20
People are around me but not with me.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.