These checklists are not intended for diagnostic or treatment purposes, and are not a substitute for an assessment or advice from a licensed professional.

The purpose is to provide information only. If, after completing a checklist, you have concerns about your health or state of mind, you should consult a licensed healthcare provider to determine the exact nature of your problem or concern. 

Check those items that describe the way you think, behave or feel most of the time.

Self Assessment Checklist for Depression

 I feel sad or down most of the time. 
 I don't sleep very well. 
 I have lost interest in things that usually give me pleasure. 
 I have very little hope for the future. 
 I don't feel good about myself.
 I usually don't experience much joy or happiness. 
 Sometimes I wish I could get away from it all. 
 I feel tired most of the time. 
 I don't feel motivated to do things like I use to. 
 I usually see the negative before I see the positive.
 I don't eat the way I should. 
 I don't feel well physically. 
 I have difficulty concentrating. 

If you checked more than two items and/or have experienced these feelings more often than not, you should seek an assessment by a professional.

Self Assessment Checklist for Anxiety

Check those items that describe the way you feel most of the time.

 I feel tense most of the time. 
 I can experience a rapid heartbeat and intense fear for no reason. 
 I worry most of the time about most things. 
 I worry frequently about my health although my doctor tells me there is nothing wrong with me. 
 I ask my doctor for medication or seek over-the-counter substances that will help calm me. 
 I have very little confidence that things will work out. 
 I experience dizziness for no apparent medical reason. 
 I hate to be in wide-open spaces.  
 I avoid social situations where there will be more than a few people. 
 I don't sleep well. 
 My appetite is not what it should be. 
 I have much difficulty staying focused on my work.

If you checked any one or more of these items and have experienced it more often than not, you should have an assessment done by a professional.

Self Assessment Checklist for an Eating Disorder

Check those items that describe your behavior or how you feel most of the time.

 I feel out of control with my eating. 
 Even though I am told I am normal weight, I think I am too fat. 
 I hate the way my body looks.
 I eat too rapidly. 
 I eat until my stomach hurts. 
 I keep telling myself I will eat just so much but end up eating much more. 
 I sometimes force myself to vomit after I eat. 
 I take laxatives and diuretics when I don't need them just to keep my weight down. 
 I am obsessed with my weight. 
 I am afraid of fat. 
 I will restrict my food intake to very little portions.  
 People tell me that I am too thin.
 I sometimes exercise excessively after I have eaten too much or the wrong kind of food. 
 I am sometimes afraid to eat because I will be out of control.
 Food and body weight control my thoughts and me.

If you experience any one or more of these items more often than not, you should seek a consultation by a professional.

Self Assessment for Addiction  

Check those that apply.

 I use illicit drugs. 
 I sometimes drive after I have had two or more drinks.
 I have been arrested for a DWI.
 I have been arrested for disorderly conduct while under the influence. 
 I use substances that have negative effects on me, my health or my life in general.
 I continue to use the same substances despite the negative effects. 
 I have been told several times that I should consider if I am an alcoholic, an addict or have a problem related to the substance(s) I use. 
 I have been to a 12 step meeting in the past because I thought it may help my drinking or drug abuse.  
 I miss school or work because of the way I feel after I use my substance of choice. 
 I spend money I don't really have to spend to keep myself supplied with the 
    substance of my choice. 
 I have history of substance abuse or addiction in my family. 
 I notice that I have to use more and more of the substance to achieve the desired result. 
 If I don't use the substance, I notice I may be on edge, irritable or experience full blown withdrawal symptoms. 
 I have been told that my personality and behavior change when I use the substance of my choice. 
 I have lost time or experienced what is commonly known as a blackout.
 I have lied to others about using the substance of my choice.
 I prefer to be alone or with friends who also use. 
 I notice that I am prone to mood swings or outbursts of anger. 
 I have not succeeded in staying away from the substance despite my desire to cease taking the substance.
 I feel out of control. 
 I have stopped doing the same things I use to do or socializing with the same people I use to because of the substance I use.

If you have checked one or more items, you may be affected by a substance use problem and should seek an assessment with a professional. 

Self Assessment for Interpersonal Problems

 I am suspicious of others. 
 I have difficulty trusting others.
 My relationships don’t last very long.
 People don’t understand me.
 I feel alone most of the time.
 I am very self-conscious around others.
 I rarely know what to say.
 I feel disappointed most of the time in my friendships and relationships.
 I am easily angered by others.
 No one every really knows the real me.
 I am terrified of others leaving me.
 I keep my real thoughts and feelings to myself.
 I am often described as emotionally cold and distant from others.
 My relationships are often very volatile and emotional.
 I feel confused about my relationships and can rarely decide what to do. 

Self Assessment for Family Issues 

 My spouse and I rarely agree about most things.
 I feel I can’t really talk to my spouse.
 My partner and I disagree about how to raise the children.
 I think about having an affair.
 I don’t think my spouse or life partner really cares about me.
 The intimacy is lost in our relationship.
 I keep most things to myself because I know it will lead to an argument.
 The children are hard to manage.
 We rarely spend time together as a family.
 There is frequent arguing and rare moments of peace and joy in the home.  

Chronic Health Issues 

 I was diagnosed with a chronic disease such as diabetes, hypertension, cardiovascular disease or other.
 I can’t seem to adjust to having the diagnosis.
 I have difficulty adhering to change in diet.
 I don’t see progress with my health problems.
 I have difficulty complying with my medication regimen on regular basis.
 I have difficulty discussing my real health issues with my doctor.
 I don’t exercise.
 I can’t manage the stress in my life.
 I don’t sleep well.
 I try not to think about my health.
 I worry about my health all the time but rarely change my behavior. 

Neuropsychological Concerns

 I have difficulty remembering routine things.
 I have difficulty following the logical progression of my own thoughts.
 I have difficulty focusing and sustaining my attention.
 I noticed I don’t perform calculations as quickly and accurately as I use to.
 I have problems with following multiple directions.
 I sometimes get lost in familiar areas.
 I have frequent headaches without an identifiable medical cause.
 I don’t learn information as quickly and as efficiently as I use to. 

Academic Performance

 I have a child or adolescent or  young adult who is performing below their potential.
 I have frequent arguments and problems with getting my children to do their homework.
 I receive complaints from school about incomplete work or homework not being done on time or at all.
 I have a child who is motivated and studies but fails tests, probably due to anxiety.
 My child is very bright but has low self esteem. He or she has no confidence.
 My child is fearful of speaking in a classroom.
 My child is disorganized in their schoolwork. 

Work Performance 

 I have difficulty performing at work.
 As a manager, I have difficulty getting employees to perform to standard.
 I want to be a good leader but my goals and objectives are rarely achieved.
 I need to develop leadership skills.
 My boss frequently provides negative feedback.
 I feel overstressed at work.
 I want to excel but have difficulty demonstrating my capabilities.
I am frequently told that I am not a good team member.
 I am performing below my potential.
 I want to move up the corporate ladder but don’t know how to go about it. 

If you have checked one or more items, you may be affected by any of problems listed above then you should seek an assessment with a professional.