Female Questionnaire
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Do you regularly suffer from a runny or drippy nose?
  • Don't know
  • No / very rarely
  • A few times a year
  • Several times a month
  • Often / most of the time


Do you suffer from nasal congestion (blocked nose) or post-nasal drip?
  • No / don't know
  • Occasionally / moderately
  • Often / severely


How moist is the inside of your nose normally, when you are not ill and not suffering from any allergic reaction?
  • Too dry
  • Quite dry
  • Normal / don't know
  • Quite moist
  • Very moist - tends to run


Has your sense of smell declined within the past few years, for reasons other than nasal congestion?
  • Don't know
  • No, my sense of smell has remained about the same
  • Yes, but it is due to ongoing nasal congestion
  • Yes, it is somewhat worse now
  • Yes, it is a lot worse now


Do you have sensations of unpleasant smells for no apparent reason?
  • No / don't know
  • Occasionally / moderate
  • Often / definite


Roughly how often do you get nosebleeds?
  • Never / rarely / don't know
  • Once or twice per year
  • 3-6 times per year
  • More than 6 times per year


Have you had sinus headaches or sinus infections (Sinusitis)?
  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) in the past, no longer a problem
  • Current minor / chronic problem
  • Current major / chronic problem


Has your nose grown abnormally large over the years? Do not include the effects of traumatic injury or a current infection that has caused swelling.
  • Don't know
  • No
  • Mildly - barely noticeable
  • Moderately
  • Significantly - I receive many comments



How 'clear' is your mind / thinking? A 'clear' mind comes quickly and accurately to conclusions; a 'foggy' mind has trouble doing calculations or making decisions that should normally be simple.
  • My mind is always/almost always 'foggy'
  • My mind is often 'foggy'
  • Average / don't know
  • My mind is usually 'clear'
  • My mind is always/almost always 'clear'


Decisiveness. How quickly do you make decisions? This is not related to how 'clear' or 'foggy' your mind is: some people with clear minds have great difficulty making a decision, and some people with foggy minds make quick decisions ('snap decisions').
  • Slowly/with difficulty - I am indecisive
  • With average speed / don't know
  • Quickly/easily - I am very decisive


Do you have difficulty concentrating, keeping your attention focused? Are you easily distracted?
  • Don't know
  • No, it is easy for me to focus on one thing
  • Yes, slight difficulty concentrating sometimes
  • Yes, I am frequently distracted
  • Yes, it is almost impossible to focus on one thing


How active do you keep your mind? For example, do you regularly read or solve problems or puzzles during work or leisure?
  • Inactive - I prefer casual conversation, TV, etc.
  • Somewhat inactive
  • I'd say I'm about average / don't know
  • More active than average
  • Extremely active - several hours each day


How spontaneous/impulsive are you? Do you think carefully before doing something, or just go ahead and do it without worrying about the consequences?
  • Not at all - I am very deliberate and cautious
  • Not very - I am usually deliberate and cautious
  • Average / sometimes I 'just do it' / don't know
  • I am often spontaneous / impulsive
  • I'm very impulsive, can't control myself


How excitable/enthusiastic are you generally?
  • Indifferent / hard to stimulate
  • Average / don't know
  • Excitable, easily stimulated


How often do you have 'racing thoughts', with your mind moving quickly from one idea to the next?
  • Never / rarely / don't know
  • Less than once a month
  • A few times a month
  • Several times a week
  • Several times a day


Sense of reality. Do you tend to see things as they really are, or as you wish them to be? For example: When you say you can do something, can you really do it, or is it often an exaggeration?
  • Always very firmly grounded in day-to-day reality
  • Average - realistic, occasional flights of fancy
  • Frequent detachment from reality, wishful thinking


How motivated are you? Are you a lethargic person (lacking in initiative, apathetic, procrastinating), or a 'type A' personality (full of 'get up and go', intense, hard-driving, often in a hurry), or somewhere in between?
  • I am very lethargic and rarely get things done
  • I am often lethargic and delay getting things done
  • About average / don't know
  • I am definitely motivated to get things done
  • I am highly motivated - a 'doer' / leader


How serious are you about major factors in your life, such as your education, career, family and future?
  • I have recently begun taking things very seriously
  • I have always taken things very seriously
  • About average / don't know
  • I have never taken things very seriously
  • I have recently developed a "don't care" attitude


How is your self-esteem / self-image?
  • Very poor, I feel completely insignificant
  • Somewhat poor, I am not very confident
  • Average / don't know
  • Good, I feel very secure about myself
  • Excellent, I feel great about myself


Sociability. By nature are you sociable or unsociable?
  • Unsocial/introverted
  • Average / don't know
  • A 'people person'/extroverted


How creative (imaginative) are you?
  • I am not creative
  • Average / don't know
  • I am very creative


Are you a perfectionist, paying close attention to detail?
  • No, I am disorderly/imprecise and rush things
  • Average / don't know
  • Yes, I am very detail oriented, slow and careful


How open are you to other people's points of view?
  • I am stubborn, often unwilling to compromise
  • Average / don't know
  • I am very open to other points of view


Do you tend to be suspicious of other people, or trusting?
  • I'm always suspicious of people and their motives
  • Often suspicious
  • I'm average, careful / don't know
  • A bit too trusting of others
  • Much too trusting and frequently 'used'


How well do you tolerate other people's mistakes and shortcomings?
  • I am not critical; I tolerate/forgive easily
  • I occasionally have difficulty tolerating people
  • I'd say I'm about average / don't know
  • I am sometimes excessively critical
  • I tend to be critical, unforgiving, quick to judge


Are you 'jumpy' or easily startled?
  • No / average / don't know
  • Quite easily
  • Very easily


Have you ever suffered significant head injury/trauma?
  • Don't know
  • No, definitely not
  • Moderate - I was knocked unconscious
  • Serious - surgery was required
  • Severe - some brain damage occurred


Do you suffer from unusual mental conditions or symptoms? For example, failing memory, Alzheimer's Disease, Dementia, Schizophrenia, OCD, mood swings, seizures, confusion, disorientation, a learning disorder, 'unreal' feelings, hallucinations.
  • Don't know
  • No
  • Yes / probably*
* more questions will be asked later



How large and available is your social support group - the circle of close friends/family that you can confide in and turn to for help and support?
  • Don't know
  • Nonexistent
  • Small and/or rarely available
  • Average
  • Large and easily available


Overall, how stressful is your lifestyle?
  • Don't know
  • Not stressful / I live a slow-paced life
  • About average / moderately stressful
  • Very stressful / I lead a fast-paced life
  • Extremely stressful / I can't really cope


Do you become exhausted after emotional upset or prolonged stress, feeling 'drained' or 'burned out'?
  • No / don't know
  • Sometimes
  • Yes, it is a frequent/ongoing problem for me


Do you collapse or go into shock from too much stress?
  • No / don't know
  • Occasionally, when under severe stress
  • It is a major problem, even with moderate stress


Do you have trouble working under pressure?
  • Not a problem / don't know
  • Mild problem, completely manageable
  • Moderate problem, causes stress
  • Serious problem, causes severe stress
  • Severe problem - completely unable to function


Have you had a problem with panic attacks?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem


Are you generally care-free, worried/anxious, or somewhere in between?
  • Always care-free, no worries in life
  • Generally care-free, not many worries in life
  • Average I suppose / don't know
  • Generally worried/anxious
  • Always worried/anxious


Approximately how often do you have feelings of insecurity? Examples include worrying about what people think of you, wondering if you are working hard enough, wondering if you are doing something wrong.
  • Never / don't know
  • Rarely - under once per month, nothing serious
  • Occasionally - a few times a month
  • Regularly, in certain situations
  • I am (almost) always insecure or self-conscious


What is the status of your relationship with the partner you are married to or living with?
  • Not applicable / I live alone / don't know
  • Very troubled
  • Unstable
  • Stable but really needs improvement
  • Stable and good


Are you experiencing any form of anguish, grief, or heartbreak?
  • No / don't know
  • Mild - I can cope quite easily
  • Moderate - I have episodes of being very upset
  • Serious - regular episodes of uncontrolled emotion
  • Severe - devastating; I can't cope with my life


Have there been any major stressful changes in your life within the past 2 years? Examples include losing a job, starting a new job, the death of a loved one, divorce or ending a long-term intimate relationship.
  • No / none within 2 years / don't know
  • There were major changes but it was easy to cope
  • Yes*
* more questions will be asked later


Have you had suicide thoughts or attempts?
  • Never / it crosses my mind sometimes / don't know
  • I think about it often / I seriously considered it
  • I tried it over 5 years ago
  • I tried it within the past 5 years
  • Tried in past year / several times in past 5 years


Do you have fears or phobias? For example, fear of heights, spiders, flying, public speaking, crowds, and so on.
  • No, I'm afraid of (almost) nothing
  • Minimal
  • Average / don't know
  • Moderate phobia / some fears, somewhat irrational
  • Severe phobia / many fears, irrational


Do you have difficult memories of traumatic events? Do not include rape or sexual/physical abuse as these will be covered separately.
  • No / don't know
  • Minor - I came to terms with them quite easily
  • Moderate - it has taken a while to overcome them
  • Serious - I avoid certain people/places/thoughts
  • Severe - flashbacks, intrusive re-experiencing


Did you suffer rape after the age of 18?
  • No / don't know
  • Probably, but it is no longer a significant issue
  • Yes, but I feel it is as resolved as it can be
  • Yes, it is still an unresolved issue for me
  • Yes, still a traumatic unresolved issue for me


Do you cry or become teary/sad for no reason?
  • No / don't know
  • Very rarely - no more than once a year
  • Occasionally - a few times a year
  • Regularly - at least once a month
  • Often - several times a week


Postpartum Depression. Have you experienced depression after childbirth?
  • No / not applicable / don't know
  • Mild - I had the 'baby blues', disappeared quickly
  • Moderate - I had some trouble bonding with my baby
  • Serious - it was hard to love/care for my child
  • Severe - I had delusions and/or harmed my child


Do you generally tend to be depressed? Include seasonal or recurring depression but not depression associated specific events such as losing a job, ending a relationship or (for women) menstrual periods or giving birth.
  • Don't know
  • No
  • Yes*
* more questions will be asked later


Have you had any Nervous Breakdowns?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem


How angry do you tend to get?
  • I am always calm/patient/agreeable
  • I am mostly calm, sometimes I might raise my voice
  • About average / I do lose my temper / don't know
  • I sometimes shout at people or break things
  • Regular shouting, intense rage, physical violence


How easily do you become irritated? This is not the same as angry. For example, are you easily annoyed by unwanted noise, other people, or things not going as planned?
  • I rarely get irritated, never seriously
  • I occasionally get mildly irritated
  • I suppose I am about average / don't know
  • I often get irritated, occasionally very irritated
  • I frequently get very irritated


How often do you get into a bad mood?
  • Don't know
  • Never/rarely - I am generally balanced/cheerful
  • I usually have a few bad moods each year
  • I am regularly in a bad mood
  • Very often - several times a week on average


How would you rate your emotional stability? Consider, for example, how you react to criticism, being cheated, or very good news.
  • I don't show any reaction, I just deal with it
  • My emotions are usually stable / controlled
  • I'm average / sometimes react visibly / don't know
  • I often react visibly to emotional triggers
  • I usually lose control / have emotional outbursts