Schema Questionnaire

Name *

First Name

Last Name

1. People have not been there to meet my emotional needs. *

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2. I haven't gotten enough love and attention. *

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3. For the most part, I haven't had someone to depend on for advice and emotional support. *

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4. Most of the time, I haven't had someone to nurture me, share him/herself with me, or care deeply about everything that happens to me. *

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5. For much of my life, I haven't had someone who wanted to get close to me and spend a lot of time with me. *

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6. In general, people have not been there to give me warmth, holding, and affection. *

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7. For much of my life, I haven't felt that I am special to someone. *

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8. For the most part, I have not had someone who really listens to me, understands me, or is tuned into my true needs and feelings. *

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9. I have rarely had a strong person to give me sound advice or direction when I'm not sure what to do. *

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10. I worry that the people I love will die soon, even though there is little medical reason to support my concern. *

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11. I find myself clinging to people I'm close to, because I'm afraid they'll leave me. *

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12. I worry that people I feel close to will leave me or abandon me. *

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13. I feel that I lack a stable base of emotional support. *

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14. I don't feel that important relationships will last; I expect them to end. *

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15. I feel addicted to partners who can't be there for me in a committed way. *

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16. In the end, I will be alone. *

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17. When I feel someone I care for pulling away from me, I get desperate. *

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18. Sometimes I am so worried about people leaving me that I drive them away. *

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19. I become upset when someone leaves me alone, even for a short period of time. *

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20. I can't count on people who support me to be there on a regular basis. *

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21. I can't let myself get really close to other people, because I can't be sure they'll always be there. *

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22. It seems that the important people in my life are always coming and going. *

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23. I worry a lot that the people I love will find someone else they prefer and leave me. *

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24. The people close to me have been very unpredictable: one moment they're available and nice to me; the next, they're angry, upset, self-absorbed, fighting, etc. *

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25. I need other people so much that I worry about losing them. *

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26. I can't be myself or express what I really feel, or people will leave me. *

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27. I feel that people will take advantage of me. *

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28. I often feel that I have to protect myself from other people. *

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29. I feel that I cannot let my guard down in the presence of other people, or else they will intentionally hurt me. *

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30. If someone acts nicely towards me, I assume that he/she must be after something. *

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31. It is only a matter of time before someone betrays me. *

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32. Most people only think about themselves. *

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33. I have a great deal of difficulty trusting people. *

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34. I am quite suspicious of other people's motives. *

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35. Other people are rarely honest; they are usually not what they appear. *

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36. I'm usually on the lookout for people's ulterior motives. *

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37. If I think someone is out to hurt me, I try to hurt him or her first. *

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38. People usually have to prove themselves to me before I can trust them. *

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39. I set up "tests" for other people, to see if they are telling me the truth and are well-intentioned. *

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40. I subscribe to the belief: "Control or be controlled." *

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41. I get angry when I think about the ways I have been mistreated by other people during my life. *

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42. During my life, those close to me have taken advantage of me or used me for their own purposes. *

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43. I have been physically, emotionally, or sexually abused by important people in my life. *

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44. I don't fit in. *

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45. I'm fundamentally different from other people. *

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46. I don't belong; I'm a loner. *

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47. I feel alienated from other people. *

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48. I feel isolated and alone. *

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49. I always feel on the outside of groups. *

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50. No one really understands me. *

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51. My family was always different from the families around us. *

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52. I sometimes feel as if I'm an alien. *

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53. If I disappeared tomorrow, no one would notice. *

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54. No man/woman I desire could love me once he/she saw my defects. *

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55. No one I desire would want to stay close to me if he/she knew the real me. *

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56. I am inherently flawed and defective. *

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57. No matter how hard I try, I feel that I won't be able to get a significant man/woman to respect me or feel that I am worthwhile. *

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58. I'm unworthy of the love, attention, and respect of others. *

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59. I feel that I'm not lovable. *

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60. I am too unacceptable in very basic ways to reveal myself to other people. *

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61. If others found out about my basic defects, I could not face them. *

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62. When people like me, I feel I am fooling them. *

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63. I often find myself drawn to people who are very critical of me or reject me. *

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64. I have inner secrets that I don't want people close to me to find out. *

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65. It is my fault that my parent(s) could not love me enough. *

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66. I don't let people know the real me. *

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67. One of my greatest fears is that my defects will be exposed. *

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68. I cannot understand how anyone could love me. *

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69. Almost nothing I do at work (or school) is as good as other people can do. *

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70. I'm incompetent when it comes to achievement. *

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71. Most other people are more capable than I am in areas of work (or school) and achievement. *

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72. I'm a failure. *

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73. I'm not as talented as most people are at their work (or at school). *

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74. I'm not as intelligent as most people when it comes to work (or school). *

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75. I am humiliated by my failures and inadequacies in the work (or school) sphere. *

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76. I often feel embarrassed around other people, because I don't measure up to them in terms of my accomplishments. *

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77. I often compare my accomplishments with others and feel that they are much more successful. *

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78. I do not feel capable of getting by on my own in everyday life. *

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79. I need other people to help me get by. *

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80. I do not feel I can cope well by myself. *

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81. I believe that other people can take of me better than I can take care of myself. *

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82. I have trouble tackling new tasks outside of work, unless I have someone to guide me. *

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83. I think of myself as a dependent person when it comes to everyday functioning. *

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84. I screw up everything I try, even outside of work (or school). *

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85. I'm inept in most areas of life. *

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86. If I trust my own judgment in everyday situations, I'll make the wrong decision. *

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87. I lack common sense. *

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88. My judgment cannot be relied on in everyday situations. *

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89. I don't feel confident about my ability to solve everyday problems that come up. *

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90. I feel that I need someone I can rely on to give me advice about practical issues. *

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91. I feel more like a child than an adult when it comes to handling everyday responsibilities. *

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92. I find the responsibilities of everyday life overwhelming. *

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93. I can't seem to escape the feeling that something bad is about to happen. *

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94. I feel that a disaster (natural, criminal, financial, or medical) could strike at any moment. *

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95. I worry about becoming a street person or vagrant. *

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96. I worry about being attacked. *

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97. I take great precautions to avoid getting sick or hurt. *

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98. I worry that I'm developing a serious illness, even though nothing serious has been diagnosed by a physician. *

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99. I am a fearful person. *

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100. I worry a lot about the bad things happening in the world: crime, pollution, etc. *

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101. I often feel that I might go crazy. *

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102. I often feel that I'm going to have an anxiety attack. *

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103. I often worry that I might have a heart attack or cancer, even though there is little medical reason to be concerned. *

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104. I feel that the world is a dangerous place. *

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105. I have not been able to separate myself from my parent(s), the way other people my age seem to. *

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106. My parent(s) and I tend to be overinvolved in each other's lives and problems. *

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107. It is very difficult for my parent(s) and me to keep intimate details from each other, without feeling betrayed or guilty. *

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108. My parent(s) and I have to speak to each other almost every day, or else one of us feels guilty, hurt, disappointed, or alone. *

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109. I often feel that I do not have a separate identity from my parents or partner. *

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110. I often feel as if my parent(s) are living through me -- I don't have a life of my own. *

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111. It is very difficult for me to maintain any distance from the people I am intimate with; I have trouble keeping any separate sense of myself. *

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112. I am so involved with my partner or parent(s) that I do not really know who I am or what I want. *

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113. I have trouble separating my point of view or opinion from that of my parent(s) or partner. *

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114. I often feel that I have no privacy when it comes to my parent(s) or partner. *

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115. I feel that my parent(s) are, or would be, very hurt about my living on my own, away from them. *

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116. I let other people have their way, because I fear the consequences. *

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117. I believe that if I do what I want, I'm only asking for trouble. *

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118. I feel that I have no choice but to give in to other people’s wishes, or else they will retaliate or reject me in some way. *

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119. In relationships, I let the other person have the upper hand. *

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120. I've always let others make choices for me, so I really don't know what I want for myself. *

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121. I feel the major decisions in my life were not really my own. *

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122. I worry a lot about pleasing other people, so they won't reject me. *

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123. I have a lot of trouble demanding that my rights be respected and that my feelings be taken into account. *

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124. I get back at people in little ways instead of showing my anger directly. *

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125. I will go to much greater lengths than most people to avoid confrontations. *

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126. I put others' needs before my own, or else I feel guilty. *

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127. I feel guilty when I let other people down or disappoint them. *

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128. I give more to other people than I get back in return. *

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129. I'm the one who usually ends up taking care of the people I'm close to. *

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130. There is almost nothing I couldn't put up with if I loved someone. *

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131. I am a good person because I think of others more than of myself. *

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132. At work, I'm usually the one to volunteer to do extra tasks or to put in extra time. *

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133. No matter how busy I am, I can always find time for others. *

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134. I can get by on very little, because my needs are minimal. *

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135. I'm only happy when those around me are happy. *

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136. I'm so busy doing for the people that I care about that I have little time for myself. *

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137. I've always been the one who listens to everyone else's problems. *

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138. I'm more comfortable giving a present than receiving one. *

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139. Other people see me as doing too much for others and not enough for myself. *

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140. No matter how much I give, I feel it is never enough. *

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141. If I do what I want, I feel very uncomfortable. *

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142. It's very difficult for me to ask others to take care of my needs. *

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143. I worry about losing control of my actions. *

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144. I worry that I might seriously harm someone physically or emotionally, if my anger gets out of control. *

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145. I feel that I must control my emotions and impulses, or something bad is likely to happen. *

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146. A lot of anger and resentment build up inside of me that I don't express. *

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147. I am too self-conscious to show positive feelings to others (e.g., affection, showing I care). *

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148. I find it embarrassing to express my feelings to others. *

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149. I find it hard to be warm and spontaneous. *

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150. I control myself so much that people think I am unemotional. *

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151. People see me as uptight emotionally. *

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152. I must be the best at most of what I do; I can't accept second best. *

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153. I strive to keep almost everything in perfect order. *

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154. I must look my best most of the time. *

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155. I try to do my best; I can't settle for "good enough." *

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156. I have so much to accomplish that there is almost no time to really relax. *

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157. Almost nothing I do is quite good enough; I can always do better. *

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158. I must meet all my responsibilities. *

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159. I feel there is constant pressure for me to achieve and get things done. *

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160. My relationships suffer because I push myself so hard. *

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161. My health is suffering because I put myself under so much pressure to do well. *

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162. I often sacrifice pleasure and happiness to meet my own standards. *

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163. When I make a mistake, I deserve strong criticism. *

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164. I can't let myself off the hook easily or make excuses for my mistakes. *

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165. I'm a very competitive person. *

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166. I put a good deal of emphasis on money or status. *

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167. I always have to be Number One, in terms of my performance. *

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168. I have a lot of trouble accepting "no" for an answer when I want something from other people. *

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169. I often get angry or irritable if I can't get what I want. *

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170. I'm special and shouldn't have to accept many of the restrictions placed on other people. *

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171. I hate to be constrained or kept from doing what I want. *

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172. I feel that I shouldn't have to follow the normal rules and conventions other people do. *

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173. I feel that what I have to offer is of greater value than the contributions of others. *

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174. I usually put my needs ahead of the needs of others. *

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175. I often find that I am so involved in my own priorities that I don't have time to give to friends or family. *

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176. People often tell me I am very controlling about the ways things are done. *

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177. I get very irritated when people won't do what I ask of them. *

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178. I can't tolerate other people telling me what to do. *

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179. I have great difficulty getting myself to stop drinking, smoking, overeating, or other problem behaviours. *

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180. I can't seem to discipline myself to complete routine or boring tasks. *

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181. Often I allow myself to carry through on impulses and express emotions that get me into trouble or hurt other people. *

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182. If I can't reach a goal, I become easily frustrated and give up. *

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183. I have a very difficult time sacrificing immediate gratification to achieve a long-range goal. *

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184. It often happens that, once I start to feel angry, I just can't control it. *

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185. I tend to overdo things, even though I know they are bad for me. *

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186. I get bored very easily. *

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187. When tasks become difficult, I usually cannot persevere and complete them. *

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188. I can't concentrate on anything for too long. *

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189. I can't force myself to do things I don't enjoy, even when I know it's for my own good. *

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190. I lose my temper at the slightest offense. *

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191. I have rarely been able to stick to my resolutions. *

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192. I can almost never hold back from showing people how I really feel, no matter what the cost may be. *

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193. I often do things impulsively that I later regret. *

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194. It is important to me to be liked by almost everyone I know. *

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195. I change myself depending on the people I’m with, so they’ll like me more. *

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196. I try hard to fit in. *

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197. My self-esteem is based mostly on how other people view me. *

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198. Having money and knowing important people make me feel worthwhile. *

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199. I spend a lot of time on my physical appearance so people will value me. *

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200. Accomplishments are most valuable to me if other people notice them. *

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201. I am so focused on fitting in that sometimes I don’t know who I am. *

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202. I find it hard to set my own goals, without taking into account how others will respond to my choices. *

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203. When I look at my life decisions, I see that I made most of them with other people’s approval in mind. *

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204. Even if I don’t like someone, I still want him or her to like me. *

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205. Unless I get a lot of attention from others, I feel less important. *

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206. If I make remarks at a meeting or am introduced at a gathering, I look forward to recognition and admiration. *

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207. Lots of praise and compliments make me feel like a worthwhile person. *

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208. Even when things seem to be going well, I feel that it is only temporary. *

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209. If something good happens, I worry that something bad is likely to follow. *

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210. You can’t be too careful; something will almost always go wrong. *

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211. No matter how hard I work, I worry that I could be wiped out financially. *

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212. I worry that a wrong decision could lead to disaster. *

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213. I often obsess over minor decisions, because the consequences of making a mistake seem so serious. *

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214. I feel better assuming that things will not work out for me, so that I don’t feel disappointed if things go wrong. *

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215. I focus more on the negative aspects of life and of events than on the positive. *

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216. I tend to be pessimistic. *

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217. People close to me consider me a worrier. *

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218. If people get too enthusiastic about something, I become uncomfortable and feel like warning them of what could go wrong. *

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219. If I make a mistake, I deserve to be punished. *

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220. If I don’t try my hardest, I should expect to lose out. *

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221. There is no excuse if I make mistake. *

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222. People who don’t “pull their own weight” should get punished in some way. *

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223. Most of the time, I don’t accept the excuses other people make. They’re just not willing to accept responsibility and pay the consequences. *

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224. If I don’t do the job, I should suffer the consequences. *

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225. I often think about mistakes I’ve made and feel angry with myself. *

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226. When people do something bad, I have trouble applying the phrase, “Forgive and forget”. *

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227. I hold grudges, even after someone has apologized. *

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228. I get upset when I think someone has been “let off the hook” too easily. *

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229. I get angry when people make excuses for themselves, or blame other people for their problems. *

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230. It doesn’t matter why I make a mistake; when I do something wrong, I should pay the price. *

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231. I “beat up” on myself a lot for things I screw up. *

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232. I’m a bad person who deserves to be punished. *

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