CORE-OM Questionnaire Test - the question form

Questions: 34 · 7 minutes
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Female form
1. Over the past week, I have felt terribly lonely and isolated.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
2. I have felt tense, anxious, or nervous.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
3. I have felt that there was someone I could turn to for support when I needed it.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
4. I have felt pleased with myself.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
5. I have felt lacking in energy and enthusiasm.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
6. I have been physically violent toward other people.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
7. I have felt able to cope when things have gone wrong.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most or all of the time
8. I have been troubled by aches and pains or other unpleasant physical sensations.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most or all of the time
9. I have had thoughts of harming myself.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
10. Talking to people was too much of an effort for me.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
11. Tension and anxiety have made it hard for me to do important things.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
12. I have been satisfied with what I have done.
Not at all
Only occasionally
Sometimes
Often
Most of the time
13. I have been troubled by unwanted thoughts and feelings.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
14. I have felt like crying.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
15. I have felt panic or terror.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
16. I have made plans to end my life.
Not at all
Only occasionally
Sometimes
Often
Most or all of the time
17. I have felt overwhelmed by my problems.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
18. I have had difficulty falling asleep or staying asleep.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
19. I felt warmth or affection for someone.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
20. I was unable to distract myself from my problems.
Not at all
Only occasionally
Sometimes
Often
Most of the time
21. I have been able to do most things I needed to do.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
22. I have threatened or intimidated someone.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
23. I have felt despairing or hopeless.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
24. I have thought it would be better if I were dead.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
25. I have felt that people were criticizing me.
Not at all
Only occasionally
Sometimes
Often
Most of the time
26. I have thought that I have no friends.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
27. I have felt unhappy.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
28. I have been upset by unwanted images or memories.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
29. I have been irritable with other people.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
30. I have thought that I was to blame for my problems and difficulties.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
31. I have felt optimistic about my future.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
32. I have achieved what I wanted.
Not at all
Rarely
Sometimes
Often
Most of the time
33. I have felt humiliated or ashamed by other people.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
34. I have harmed myself physically or put myself at serious risk to my health.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
1. Over the past week, I have felt terribly lonely and isolated.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
2. I have felt tense, anxious, or nervous.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
3. I felt that I had someone to turn to for support when I needed it.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
4. I have felt satisfied with myself.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
5. I felt lacking in energy and enthusiasm.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
6. I have been physically violent towards other people.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
7. I have felt able to cope when things went wrong.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
8. I have been troubled by aches and pains in my body or other unpleasant physical sensations.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
9. I have had thoughts of harming myself.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
10. Talking to people felt too difficult for me.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
11. Feeling tense or anxious has made it difficult for me to do important things.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
12. I felt pleased with what I had done.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
13. I have been troubled by unwanted thoughts and feelings.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
14. I have felt like crying.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
15. I have felt panic or terror.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
16. I have made plans to end my life.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
17. I felt overwhelmed by my problems.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
18. I have had difficulty falling asleep or staying asleep.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most or all of the time
19. I have felt warmth or affection for someone.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
20. I could not take my mind off my problems.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
21. I was able to do most things I needed to do.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
22. I have threatened or intimidated someone.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
23. I have felt despairing or hopeless.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
24. I have thought it would be better if I were dead.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
25. I have felt criticized by other people.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
26. I have felt I have no friends.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most or all of the time
27. I have felt unhappy.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
28. I have been upset by unwanted images or memories.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
29. I have been irritable when dealing with other people.
Not at all
Only occasionally
Sometimes
Often
Most of the time
30. I have felt that I was to blame for my problems and difficulties.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
31. I have felt optimistic about my future.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most or all of the time
32. I have achieved what I wanted to achieve.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
33. I have felt humiliated or ashamed by other people.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
34. I have physically harmed myself or put myself at serious risk of harm.
1 – Not at all
2 – Only occasionally
3 – Sometimes
4 – Often
5 – Most of the time
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