Inventory: Self

Please complete this form before your first session with Dr. Warsaw.

Rate each statement below: 0=Never, 1=Rarely, 2=Sometimes, 3=Often, 4=Always

I experience episodes of a racing heart or breathlessness without exertion or a diagnosed physical illness.

I find myself losing my temper over minor matters or snapping at others with little provocation

I lack the energy to do things.

I am not interested in eating, or I eat excessively.

I am concerned about my sleep habits.

I have little to look forward to.

I find it difficult to make decisions.

I have little or no interest in activities that used to bring me pleasure.

I have difficulty being assertive.

I am afraid that something bad is going to happen to me.

I become angry when I am interrupted.

I have feelings of worthlessness or guilt.

I find it hard to calm down when I become upset.

I feel shaky or nervous over trivial matters – or for no apparent reason.

I am told I overreact or blow things out of proportion.

I worry about my physical health.

I feel like crying but tears never come.

I find it difficult to complete tasks.

I experience gastrointestinal issues – such as stomachache, nausea or diarrhea – for no known medical reason.

I spend money to make myself feel better.

Named Best Counselor on Kudzu.com for Years. Highly Rated on Google Reviews: Dr. George Warsaw, Psychotherapist, Coach & Counselor.