Check off the numbers that you agree with.
- alternative: rate each number from 0 - 5, where 0 = does not apply, 5 = strongly applies, and 1-4 is gradation between.
- I have difficulty saying “no” when people ask me to do something, even when I know I should not do it.
- I reel responsible for the problems of others and the world that I did not cause.
- I have a hard time being good to myself. It feels so selfish!
- I put others’ needs before my own, even when their needs are not urgent and mine are.
- When other people give me approval, it helps me to accept myself.
- When other people criticize something I do, I feel like a failure.
- I put off doing or saying things which upset people to avoid “making a scene.”
- In the areas of my life where I experience approval, I often become over-involved.
- If something I do is not done perfectly, I become impatient.
- When others point out an imperfection in me, I become defensive.
- If I am not in control of a situation or project, I feel panicky.
- I frequently compare myself with other people to see if I’m OK.
- When I’m around other people who seem to “have it together,” I feel inadequate.
- Deep down inside, I don’t really like myself, and I hide this from others.
- When I feel upset, I tend to blame and criticize people and circumstances for my feelings.
- I have a difficult time getting myself out of unhealthy relationships with others.
- I sometimes compromise my values to stay in unhealthy relationships with others.
- I have a difficult time asking people to help me do things I cannot do myself.
- I often feel burdened with the attitude, “If I don’t do it, then no one else will.”
- My first reaction to a suggestion to try something new is generally negative.