1. Do you have problems making decisions?

Yes No

2. Do you have problems sleeping?

Yes No

3. Do you get tired easily?

Yes No

4. Do you lack appetite?

Yes No

5. Do you have problems with your self-esteem?

Yes No

6. Are you having problems with your sexual interests?

Yes No

7. Do you sometimes feel like a failure?

Yes No

8. Do you have a problem of feeling disappointed all the time?

Yes No

9. Are you irritated all the time?

Yes No

10. Do you have a problem expressing your feelings?

Yes No