1 – Never
2 – Once or twice in my life
3 – No more than once a year
4 – Once every few months
5 – At least once a month
6 – At least once a week
7 – Multiple times a week
8 – Daily
¹
1
2
3
4
5
6
7
8
1
When listening to someone talk, I suddenly realize I do not hear part or all of what was said.
2
What I see looks “flat” or “lifeless,” as if I am looking at a picture.
3
I focus on something going on in my mind and more or less lose track of what is happening around me.
4
I feel like I am watching a situation as an observer or spectator.
5
I feel divided, as if I have several parts or forces that have feelings, ideas, memories and behaviours that I do not regard as my own.
6
I feel as if something or someone has possessed me.
7
At times I go into a trance-like state in which I am barely aware, or unaware, of what is happening around me.
8
I cross the street where there is no pedestrian crossing or crosswalk (i.e., jaywalk).
9
I have strong feelings that do not seem to belong to me.
10
For no medical or physical reason I cannot feel all or parts of my body.
11
I feel detached from memories of things that have happened to me, as if I had not been involved in them.
12
I “blank out” or “space out” or my mind goes totally empty.
13
People tell me that my behaviour changes drastically, or that I seem like a different person.
14
I find myself in a place and have no idea how I got there or why I am there.
15
I tell a small lie to stop someone being disappointed or cross with me.
16
At times I feel disconnected from a body that does not seem like mine.
17
Something inside of me seems to make me do things that I do not want to do.
18
I feel mechanical, like a robot or like I'm not really human.
19
I look at the clock and realize that time has gone by and I cannot remember what has happened.
20
I do not feel in control of what my body does, as if there is someone or something inside me directing my actions.
21
I switch back and forth between feelings that seem to belong to me, and feelings that I do not experience as my own.
22
I feel my sense of time changes and things seem to happen in slow motion or in double time.