A Des PDF
A Des PDF
A Des PDF
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(always)
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Date: ____________________
Age: ______
Sex: M F _____________
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3. I have strong feelings that dont seem like they are mine.
0
1
(never)
4. I can do something really well one time and then I cant do it at all another
time.
0
1
(never)
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(always)
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6. I feel like I am in a fog or spaced out and things around me seem unreal.
0
1
(never)
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(always)
7. I get confused about whether I have dones something or only thought about
doing it.
0
1
(never)
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(always)
8. I look at the clock and realize that time has gone by and I cant remember what
has happened.
0
1
(never)
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(always)
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(always)
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10. When I am somewhere that I dont want to be, I can go away in my mind.
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1
(never)
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(always)
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14. I find myself going somewhere or doing something and I dont know why.
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1
(never)
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(always)
15. I find myself someplace and I dont remember how I got there.
0
1
(never)
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(always)
18. I cant figure out if things really happened or if I only dreamed or thought
about them.
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1
(never)
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(always)
19. I find myself doing something that I know is wrong, even when I really dont
want to do it.
0
1
(never)
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20. People tell that I sometimes act so differently that I seem like a different
person.
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(never)
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(always)
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22. I find writings, drawings or letters that I must have done but I cant remember
doing.
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(never)
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(always)
23. Something inside of me seems to make me do things that I dont want to do.
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1
(never)
10
(always)
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(always)
25. I find myself standing outside of my body, watching myself as if I were another person.
0
1
(never)
10
(always)
26. My relationships with my family and friends change suddenly and I dont
know why.
0
1
(never)
10
(always)
27. I feel like my past is a puzzle and some of the pieces are missing.
0
1
(never)
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(always)
28. I get so wrapped up in my toys or stuffed animals that they semm alive.
0
1
(never)
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