Male Questionnaire
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SYMPTOMS: MIND: GENERAL

Q312

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'

Q313

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

Q314

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

Q315

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

Q316

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

Q317

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

Q318

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

Q319

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

Q320

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

Q321

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

Q322

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

Q323

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

Q324

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

Q325

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

Q326

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

Q327

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'

Q328

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

Q329

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

Q330

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

Q331

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

SYMPTOMS: MIND: EMOTIONAL

Q332

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

Q333

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

Q334

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

Q335

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

Q336

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

Q337

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

Q338

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

Q339

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

Q340

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

Q341

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

Q342

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

Q343

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

Q344

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

Q345

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

Q346

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

Q347

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

Q348

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

Q349

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

Q350

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

Q351

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

Q352

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

SYMPTOMS: GLANDULAR

Q353

Do you have Diabetes?
  • Don't know
  • No, it has been ruled out within the past 6 months
  • Yes*
* more questions will be asked later

Q354

Do you suffer from Hypoglycemia (abnormally low blood glucose level)?
  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current significant problem

Q355

  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current significant problem

Q356

  • Never had it / not sure / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem, confirmed
  • Current significant problem, confirmed

Q357

Do you have a swelling at the front of your neck?
  • Don't know
  • Definitely not
  • Possibly - I'm not sure
  • Yes, minor
  • Yes, major / pronounced

Q358

Have you suffered from Adrenal Insufficiency?
  • Uncertain / don't know
  • No, lab tests have confirmed normal function
  • It is a suspected problem
  • Yes, a lab test has confirmed it
  • I have confirmed Addison's Disease

Q359

Have you had any swollen, tender or painful lymph nodes within the past year? They appear as small, smooth lumps under the skin. If in doubt, the link above has more information.
  • Don't know
  • No
  • Yes*
* more questions will be asked later