SCL—90—R® SIDE1 INSTRUCTIONS: ) LSE | | ame — Below is a list of problems people sometimes have. Please read each one carefully, andcircle thenumberto | | MA® | | Location: oe the right that best describes HOW MUCH THATPROB- | | © LEM HAS DISTRESSED OR BOTHERED YOU DUR- | EDUCATION: ING THE PAST 7 DAYS INCLUDING TODAY. Circle | | revace ‘only one number for each problem and donot skipany | | © | | maniTacsTatus:man—sep—ow—wio_sino— items. If you change your mind, erase your first mark refully. Read the example below before beginning, and if you have any questions please ask about them. DATE D I wo [oay [vean] | numeer | [ASE Cor Cort | EXAMPLE an How MUCH WERE YOU DISTRESSED BY. visiT NUMBER: — 1. Bodyaches r ~ — 2 ORES HOW MUCH WERE YOU DISTRESSED BY: AN AN ARAN %\S\t\e\% 1. Headaches afo]? a [4 2. Nervousness or shakiness inside 2}o]4 ala 3. Repeated unpleasant thoughts that won't leave your mind 3}o]1 af 4. Faintness or dizziness ajo] ala 5. Loss of sexual interest or pleasure si|o|]t 3,4 6. Feeling critical of others 6) o|1 ala 7. The idea that someone else can control your thoughts 7Lo}t a} 8. Feeling others are to blame for most of your troubles alo]1 a] 9. Trouble remembering things glo] a}a| 10. Worried about sloppiness or carelessness yo|o | 1 a) 4 11. Feeling easily annoyed or irritated a{o] 4 ala 12. Pains in heart or chest 12] 0] 1 a4 13. Feeling afraid in open spaces or on the streets 13/0] 1 a} 14. Feeling low in energy or slowed down 14) o} 1 a] 4 15. Thoughts of ending your life 15| 0] 1 alfa 16. Hearing voices that other people do not hear 16] 0] 3 a] 4 17. Trembling fol 3] 4 18. Feeling that most people cannot be trusted aafo| 3 aja 19. Poor appetite ig}o| 1 a}4 20. Crying easily . 20| 0/1 a} 21. Feeling shy or uneasy with the opposite sex aijo] 4 a| 4 22. Feelings of being trapped or caught 22/0] 1 a|4 23. Suddenly scared for no reason 23/0 | 1 ala 24. Temper outbursts that you could not control zalo| 3 3}a4 25. id to go out of your house alone 25yo] 1 3a] 4 26. Blaming yourself for things 26) 0] 1 3}4 27. lower back 27;o| 1 a|4 28. Feeling blocked in getting things done 2e}o} 1 aja 29. Feeling lonely 29} 0| 1 a}4 30. Feeling blue 30} 0 | 1 a|4 31. Worrying too much about things 31/0} 1 3| 4 | 32. Feeling no interest in things 32/0] 1 a]a | 33. Feeling fearful 33} 0 | 1 s|4 | 34. Your feelings being easily hurt 34{o] a4 35. Other people being aware of your private thoughts 35{o| 1 sia Copyright > 1975 by leonard R. Derogatis. Ph D. — ‘onthe following page bp