First Name / Last Initial
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1. I am more aware of what I think than what I feel.
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2. I have difficulty believing that I am competent even when I’m successful.
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3. I don’t feel like I can count on the people to whom I’m attached to be reliable and predictable.
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4. I have a tendency to be absentminded.
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5. Separations have always been difficult for me (e.g., starting school, going to high school, leaving home, graduating college, leaving a job or a relationship).
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6. I have a tendency to get jealous that my partner will love someone else more than me.
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7. My family is proud of my talents and special abilities.
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8. I’m having a hard time leaving a relationship or job where I feel criticized, rejected, devalued, and/or hurt.
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9. I have a tendency to think that problems with other people are all my fault.
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10. I get very angry when I feel criticized.
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11. I have great difficulty making decisions.
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12. Spending time all alone is very difficult for me.
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13. I have extremely intense moods that seem to change rapidly.
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14. I spend most of my time daydreaming and having fantasies.
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15. I feel either very important or very unworthy.
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16. I have been told that I behave seductively and have been surprised as that was not my intention.
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17. I strive “never” to make a mistake.
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18. I often feel terrified, like a “baby alone in space.”
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19. I am an objective, neutral observer of life.
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20. I have been described as eccentric.
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21. I don’t have any idea about who I really am, what I want, or what is truly important to me in life.
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22. While I find triangular relationships to be very difficult (e.g., having two friends that know each other well, having a partner who has an extremely close friend with whom I feel competitive), I often find myself in these types of situations.
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23. When I put aside my accomplishments, I am not really sure who I am.
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24. I have a very hard time apologizing.
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25. While I never have made suicide attempts or would kill myself, on a number of occasions I’ve wanted to die just to end my feelings of pain.
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26. I have been told that I’m argumentative.
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27. I feel secretly proud of my extreme self-sufficiency.
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28. I frequently feel detached from my needs and feelings.
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29. I am painfully shy.
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30. When I am rageful or depressed, I have done things to hurt myself physically (e.g., suicide attempts, self-mutilation).
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31. I have a tendency to get into struggles with people, even over small things, because I don’t like feeling controlled by people (i.e., forced into doing something that I don’t want to do or don’t agree with).
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32. I have been told that I’m dramatic.
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33. I need a lot of reassurance.
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34. My relationships generally tend to be short and intense.
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35. I’m afraid that, deep down, people like me for the things that I do for them, rather than for who I am.
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36. My parents paid the most attention to me when I had some sort of problem (e.g., misbehaved, was ill).
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37. Despite my initial intentions in a relationship, I usually find myself taking care of or being responsible for the other person.
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38. It is very important to me that my partner is attractive, intelligent, appreciative of me, and a good listener.
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39. When I ask people for advice, I experience a great conflict between wanting to please them so that they will like me (i.e., taking their advice) and wanting to be my own person (i.e., making my own decision).
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40. I frequently feel bored and empty inside.
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41. I was physically and/or sexually abused as a child to an extreme degree.
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42. I often feel panicked that people will abandon me.
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43. My physical appearance is very important to me.
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44. I don’t enjoy eating as much as other people seem to (i.e., I eat to live rather than live to eat).
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45. I tend to do things to an extreme (e.g., I’m either very messy or very neat, very rational and logical or lose my temper).
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46. My sexual fantasies are almost always about doing something that is forbidden.
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47. Losing a relationship with someone that I love would be more painful to me than anything else.
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48. At times, I have had strange and unusual experiences (e.g., seeing or hearing things that are not there, believing things that no one else believes).
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49. I live by myself and have few, if any, relationships.
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50. I expect a great deal from people, have difficulty taking no for an answer, and persist in my attempts to get what I want. If people don’t eventually go along with what I want, they can be replaced.
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51. As a child, when I went off and played by myself or made friends with other children, my mother acted rejecting toward me.
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52. I was the scapegoat (e.g., my family thought that I was “bad” or “screwed up”) or caretaker (e.g., I was my parent’s confidant, I was given too much responsibility for a child my age) in my family.
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53. I am the happiest when I have a relationship with someone (e.g., friend, teacher, partner) that I greatly admire and identify with.
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54. I value work and productivity over spending time in leisure activities or with other people.
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55. I am more emotional than analytical or logical.
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56. I have high moral standards and try to be conscientious.
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57. I feel detached from other people.
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58. Life often feels futile, meaningless, and unreal.
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59. In sexual relationships, I have a tendency to be attracted to people who initially appear to be particularly loving, romantic, and/or seductive but then begin to frequently behave in a cruel or rejecting manner toward me.
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60. I feel driven at times to accomplish my goals, even when I know it is not really in my best interest.
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61. While people tend to find me likable and entertaining, I do not really have intimate relationships with friends (i.e., people with whom I frequently spend leisure time, who I can share things that I feel embarrassed or guilty about, who are very important to me and that I can depend on).
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62. I feel guilty and/or embarrassed about my sexual fantasies and desires.
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63. Things feel black and white to me. When I like and feel supported by someone, I think that they’re absolutely perfect. When they disappoint me and I get angry at them, it’s difficult for me to remember anything good about them.
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64. Given a choice, I value spiritual pursuits over pleasures in daily living.
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65. It is very important to me that other people do things the way that I tell them to do them, especially when I’m quite certain that my way is the correct approach.
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66. I have been told that I have an innocent or childlike manner.
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67. I frequently struggle with feelings of low self-esteem, especially when someone important to me is critical and/or angry at me.
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68. What a talented person can accomplish in this world is unlimited.
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69. It’s hard for me to do things for other people that I do not want to do without feeling as though I am giving a part of myself up.
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70. One or both of my parents (or a sibling) was quite unpredictable in their behavior toward me (i.e., alternated from being very loving, attentive, and/or fun to be with to being moody, critical, withdrawn, or even abusive).
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71. Sometimes when I speak, although I’m quite logical, other people seem to have difficulty following my ideas.
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72. My same-sex parent was somewhat cold and uninterested in me but my opposite-sex parent was more involved with me, warmer, and was someone who other people experienced as funny, charming, or even somewhat flirtatious (if heterosexual). If gay or lesbian, the situation is reversed.
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73. I have felt, at times, that I had no right to exist.
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74. I tend to look at the big picture. I am not at all a detail person.
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75. While I have emotional outbursts, I don’t stay mad for long and am able to apologize to or forgive the person that I’m mad at.
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76. Being right (particularly when other people acknowledge it) is very important to me.
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77. People tend to like me because I know how to make them feel really important and special.
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78. I tend to adore/admire people at first and to then get very disillusioned in them.
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79. I would like to live alone somewhere that is remote and peaceful.
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80. Separations from people that I am attached to are almost unbearable for me.
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81. Sometimes, when I think that I’m trying my best to be nice and cooperative, people seem to get irritated with me and I don’t really understand why.
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82. I often have the experience of being “one” with people in my life. When I do, I both like it and feel frightened by it.
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83. The emotion that I feel the most frequently is a combination of rage and self-hatred.
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84. I have difficulty compromising, especially when I know that my way is the right way.
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85. I tend to notice details and can lose sight of the big picture at times.
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86. I tend to act somewhat impulsively and to think about it afterward. However, this doesn’t usually cause me great harm.
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87. I don’t believe that people will respect or be interested in me unless I’m perfect (e.g., brilliant, exceptionally attractive, thin, successful).
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88. I believe that I could get what I need from my parent(s) or partner, if only I could figure out the right thing to do.
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89. People say that they experience me as cool and aloof.
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90. I frequently make lists to organize my activities but have difficulty completing things on the list according to schedule.
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