Stress Symptoms Checklist

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Put a check beside each item that reflects your current physical or emotional state. Next, rate the level of severity by circling a number next to the statements you checked.

Scoring: Add up the total points on all items.
If your score is over 100, you might benefit from some specific stress management counseling.


Check Symptom Very mild Mild Moderate Severe Very Serve
  Feeling Bored 1 2 3 4 5  
  Difficulty Making Decisions 1 2 3 4 5  
  Easily upset over little things 1 2 3 4 5  
  Difficulty concentrating 1 2 3 4 5  
  Irritability 1 2 3 4 5  
  Procrastination 1 2 3 4 5  
  Feeling persecuted 1 2 3 4 5  
  Feeling unexplained dissatisfaction 1 2 3 4 5  
  Forgetfulness 1 2 3 4 5  
  Accident proneness/unusual clumsiness 1 2 3 4 5  
  Confusion 1 2 3 4 5  
  Loss of or increase in appetite 1 2 3 4 5  
  Loss of energy 1 2 3 4 5  
  Weight loss or weight gain 1 2 3 4 5  
  Change in appearance 1 2 3 4 5  
  Difficulty breathing 1 2 3 4 5  
  Increase in smoking habits 1 2 3 4 5  
  Change in use of alcohol 1 2 3 4 5  
  Allergies or new allergies 1 2 3 4 5  
  Change in social habits 1 2 3 4 5  
  Taking oneself too seriously 1 2 3 4 5  
  Being late for work, school, appointments 1 2 3 4 5