Symptoms: Check all that Apply

I'm tired all the time, even after a full night's rest.

I have trouble falling asleep, sleep restlessly or wake up much too early.

It's getting harder and harder just to get up in the morning.

I have a constant ache in my stomach and/or suffer from ulcers, gastritis or irritable/inflammatory colon.

I get dizzy spells and heart palpitations or suffer pain that no doctor has been able to diagnose.

I tend to overeat.

I consume more alcohol than I should and/or rely on unprescribed drugs.

I sometimes I go on shopping sprees and spend more than I can afford.

I've been really accident-prone lately.

I frequently burst into tears, and I don't know why.

Thoughts and Feeling: Check emotions you agree with or have felt recently

Life is basically meaningless.

Every day is just like the next - what's the point?

Almost no one understands or cares about me.

Why won't everyone just leave me alone?

No matter how hard I try, I always fail.

I have to do everything myself - nobody will lend a hand.

My co-workers are a bunch of idiots/are out to sabotage my job.

I don't know how much longer I can continue to cope.

Sometimes I just want to end it all.

Stressors: Check conditions that apply to you

Work

I don't get paid near enough for what I do.

I'm qualified for a much better job.

There's never enough time to finish all my work.

My job involves solving crises on a regular basis.

I could use a lot more help in doing my job.

I've been missing a lot of work lately, and I'm always in trouble on the job.

My job interferes with my personal life.

My boss/co-workers are unsupportive/critical.

I could lose my job at any time.

Personal:

I am recently divorced.

My marriage is in trouble.

I am raising children as a single parent.

I am a caregiver for someone who is not able to care for him/herself.

Someone I loved has just died or left me. I am retired. I have money problems.

I am an adolescent/child experiencing school or family problems.