By completing the following survey, we can identify some impairments and traits that may be keeping us from living the life we want to live. We can give our-self a score between 1 and 10,  with 1 being “no problem” and 10 being “a major problem that is making my life difficult”. We can then make a note of those items where the score is five or higher. These are areas you may want to work on over the next few weeks as we look at ways to turn these negative problems into  positive solutions. 

  1. Markedly impoverished, poorly developed, or unstable self-image,  ______
  2. Excessive self-criticism;  ______
  3. Chronic feelings of emptiness;  ______
  4. Dissociative states under stress ______
  5. Instability in goals, aspirations, value, or career plans   ______
  6. Compromised ability to recognize the feelings and needs of others ______
  7. interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); ______
  8. Perceptions of others selectively biased toward negative attributes or vulnerabilities  _____
  9. Intense, unstable, and conflicted close relationships;  ______
  10. Marked by mistrust, neediness;  ______
  11. Anxious preoccupation with real or imagined abandonment;  ______
  12. Close relationships often viewed in extremes of idealization and devaluation;  ______
  13. Alternating between over involvement and withdrawal. ______
  14. Unstable emotional experiences and frequent mood changes;  ______
  15. Emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. ______
  16. Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; ______
  17. Worry about the negative effects of past unpleasant experience and future negative possibilities;  _____
  18. Feeling fearful, apprehensive, or threatened by uncertainty;  ______
  19. Fears of falling apart or losing control;  ______
  20. Pathological personality traits in negative affectivity;  ______
  21. Fears of rejection by – and/or separation from – significant others;  ______
  22. Fears of excessive dependency and complete loss of autonomy;  ______
  23. Frequent feelings of being down, miserable, and/or hopeless; ______
  24. Difficulty recovering from such moods;  ______
  25. Pessimism about the future; ______
  26. Pervasive shame; ______
  27. Feeling of inferior self-worth;  ______
  28. Thoughts of suicide and suicidal behaviour;   ______
  29. Acting on the spur of the moment in response to immediate stimuli; ______
  30. Acting on a momentary basis without a plan or consideration of outcomes;  ______
  31. Difficulty establishing or following plans; ______
  32. A sense of urgency and self-harming behavior under emotional distress;______
  33. Engagement in dangerous, activities, unnecessarily and without regard to consequences;  ______
  34. Lack of concern for one’s limitations;  ______
  35. Denial of the reality of personal danger. ______
  36. Persistent or frequent angry feelings;  ______
  37. Anger or irritability in response to minor slights and insults. ______

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