|
|
Never
1 point
|
Rarely
2 points
|
Sometimes
3 points
|
Fairly Often
4 points
|
Always
5 points
|
|
I feel nervous, and shake or sweat a lot:
|
|
|
|
|
|
|
I feel tired or have a lack of energy:
|
|
|
|
|
|
|
I have headaches:
|
|
|
|
|
|
|
I have trouble sitting still or concentrating:
|
|
|
|
|
|
|
I have problems getting to or staying asleep at night:
|
|
|
|
|
|
|
I feel pain in my chest and shortness of breath:
|
|
|
|
|
|
| I am constipated or have diarrhea:
|
|
|
|
|
|
|
I have an upset stomach and muscle aches, especially in my back, neck, or shoulders:
|
|
|
|
|
|
|
I have gained or lost more than 10 pounds:
|
|
|
|
|
|
|
YOUR TOTAL SCORE:
|
|