Do you have a 'type A' personality: intense, hard-driving, often in a hurry?
No / don't know
Somewhat
Yes, definitely
452.
Motivation. Are you...?
Lacking in initiative/apathetic/procrastinating
Average / don't know
Highly motivated - a 'doer' / leader
453.
How is your self-esteem / self-image?
Very poor
Somewhat poor
Average / don't know
Good
I feel great about myself
454.
Sociability. By nature are you...?
Antisocial/introverted
Average / don't know
A 'people person'/extroverted
455.
Is your short-term memory failing? Examples of failure include forgetting what you were talking about or why you entered a room, or not being able to remember phone numbers before writing them down.
Are you experiencing any form of anguish, grief, or heartbreak?
No / don't know
Mild
Moderate
Serious
Severe - devastating
469.
Have you had suicide thoughts or attempts?
Never / don't know
I thought of it as an option
I seriously considered it
I actually attempted it over a year ago
Attempted within past year, or several attempts
470.
Have you recently endured the death of a loved one?
No / over 2 years ago / don't know
Within the past 2 years
Within the past year
Within the past 6 months
Within the past 3 months
471.
Do you have fears or phobias?
No, I'm afraid of (almost) nothing
Minimal
Average / don't know
Moderate phobia / some fears, somewhat irrational
Severe phobia / many fears, irrational
472.
Do you have difficult memories of traumatic experiences? Do not include rape or sexual / physical abuse as these will be covered separately.
No / don't know
Minor
Moderate
Serious - I avoid certain people/places/things
Severe - flashbacks, intrusive re-experiencing
473.
Do you cry or become teary / sad for no reason?
No / don't know
Occasionally
Often
474.
How often to do you laugh?
Don't know
Never / rarely
Occasionally
At least daily
Many times during the day
475.
As far as you know, has depression or a depressive tendency been a problem for you? This includes seasonal or recurring episodes but not depression associated with menstrual periods or giving birth.
Don't know
No
Yes More questions later...
476.
Approximately how often do you have feelings of insecurity? Examples include worrying about what people think of you, or wondering if you are working hard enough.
Never / don't know
Rarely - under once per month
Occasionally (under once per week) and moderate
Occasionally severe or often moderate
Often (once per week or more) and severe
477.
How would you rate your irritability or usual level of irritation?
I rarely get irritated, never severely
I occasionally get mildly irritated
I suppose I am average / don't know
I sometimes get very irritated
I frequently get very irritated
478.
Disposition. Are you...?
Always calm / not easily ruffled/patient/agreeable
Mostly calm / not easily ruffled/patient/agreeable
Average / don't know
Sometimes tense / easily angered/impatient/hostile
Often tense / easily angered/impatient/hostile
479.
Are you generally moody and somewhat emotional by nature?
If you are hyperactive, are you also generally exhausted?
No / does not apply / don't know
Moderately
Severely
494.
Do you suffer from the incurable genetic lung disease known as cystic fibrosis?
Don't know
No
Yes
495.
How would you rate your stamina?
I have poor endurance
I'm about average / don't know
I have strong endurance
496.
Do you experience inappropriate sweating during the day? Only include sweating that is not explained by a hot / humid climate, exertion or dressing too warmly.
Don't know
No
Occasionally
Frequently, mild to moderate
Frequently and severe
497.
Do your feet have a strong odor and / or sweat easily?
Don't know
No
Moderately
Severely
498.
Do you suffer from fluid retention (edema), often seen on feet, ankles or lower legs? To rate its severity more accurately, press firmly with a finger for 5 seconds and note the approximate depth of the indentation or length of time to return to normal.
No / don't know
Slight: 5mm (1/4 inch) depth, immediate recovery
Minor: 8-10mm (1/2 inch) depth, 10-15 seconds
Moderate: 11-20mm (3/4 inch) depth, 15-30 seconds
Severe: Over 20mm (1 inch) depth, over 30 seconds
499.
Do you find that flu / influenza stays longer and hits harder than for other people?
No / don't know
Moderately
Severely - they knock me out for a long time
500.
Do you have frequent colds or flus?
No / don't know
2-3 per year
More than 3 per year
501.
Do you currently have a fever?
Don't know
No
Mild, on average 99-100F (37.2-37.8C)
Moderate, averaging 100.1-103F (37.8-39.4C)
High, usually over 103F (39.5C)
502.
How often do you get unexplained fevers? Unexplained by obvious causes, such as the flu.
Never / rarely / don't know
Occasionally - one or two per year
Frequently - several per year
503.
If you suffer from unexplained recurring fever, how would you rate the average severity?
Not applicable / don't know
Very mild
Mild
High
Very high - I'm bedridden
504.
Do you sometimes experience 'chills' (sensations of cold accompanied by shivering / shaking) that can not be explained by your environment?
Don't know
No
Occasionally
Often - more than once a month
I am sick and experiencing real chills
505.
Do you have cold spells that can not be explained by your environment?
No / don't know
Occasionally / mild
Often / moderate
Very frequently / severe
506.
Have headaches been or currently are a problem for you?
Don't know
No, not especially
Yes, but in the past only
Yes More questions later...
507.
Do you feel shaky, headachy, tired, faint or nauseous when meals are delayed?
Does your body temperature, during the day and under normal conditions, sometimes measure below 98.0 degrees F (36.7 degrees C)? Only answer this if you are confident that your answer is accurate.
Uncertain / don't know
Definitely not
Occasionally a little lower
Often a little lower or occasionally much lower
Regularly much lower
511.
Do you know your approximate percentage body fat?
Don't know
6-13% / low
14-17% / average / desirable
18-25% / high
Over 25% / high, obese
512.
Do you have any problems with your weight? This includes being under/overweight, difficulty maintaining weight, a history of serious weight gains and losses, unexplained weight changes, weight distribution shift, etc..
Don't know
No
Yes More questions later...
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GLOSSARY
Adrenal Insufficiency: Also known as Adrenal Exhaustion or Low Adrenal Function, this is a condition where the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Allergic Rhinitis: Also known as hay fever, this is an inflammation of the nasal mucous membranes that is caused by specific allergen(s). It is an allergy characterized by sneezing, itchy and watery eyes, a runny or stuffy nose, coughing and a burning/scratchy sensation of the palate and throat.
Allergy: Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Alzheimer's Disease: A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Anxiety: Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Bipolar Disorder: Also known as manic-depression, this disorder is characterized by alternating periods of extreme moods, usually swinging from being overly elated or irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal mood in between. The frequency of the swings between these two states, and the duration of the mood, varies from person to person.
Cancer: Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Celiac Disease: (Gluten sensitivity) A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Cystic Fibrosis: (CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.
Dementia: An acquired progressive impairment of intellectual function. Marked compromise exists in at least three of the following mental activity spheres: memory, language, personality, visuospatial skills, and cognition (i.e., abstraction and calculation).
Diabetes Mellitus: A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Edema: Abnormal accumulation of fluids within tissues resulting in swelling.
Glucose: A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.
Gynecomastia: Occurs when the male breast is enlarged. The size can vary from a slight puffiness to full female-like breasts. It literally means "female-like breasts".
Hallucination: A false or distorted perception of objects or events, including sensations of sight, sound, taste, smell or touch, typically accompanied by a powerful belief in their reality.
Hyperthyroidism: An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Hypoglycemia: A condition characterized by an abnormally low blood glucose level. Severe hypoglycemia is rare and dangerous. It can be caused by medications such as insulin (diabetics are prone to hypoglycemia), severe physical exhaustion, and some illnesses.
Hypothyroidism: Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Long-Term Memory: The final phase of memory in which information storage may last from hours to a lifetime.
Lymph Nodes: Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit and groin, but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Children’s nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's.
Metabolism: The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Nervous Breakdown: This is an unofficial term for an event experienced by someone when anxiety or depression escalates to the degree that they find themselves suddenly unable to perform normal functions.
Obsessive-Compulsive: People with Obsessive-Compulsive Disorder (OCD) have obsessions and/or compulsions. Obsessions refer to recurrent and persistent thoughts, impulses, or images that are intrusive and cause severe anxiety or distress. Compulsions refer to repetitive behaviors and rituals (such as hand washing, hoarding, ordering, checking) or mental acts (like counting, repeating words silently, avoiding). These obsessions and compulsions significantly interfere with normal routine, functioning, social activities and relationships.
Pancreatitis: Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.
Panic Attack: A brief, irrational episode of fear that is perceived as so real that an individual may be driven to escape from the place or situation where it occurs. The attack is sudden and increases in severity until it leaves, usually within ten minutes. Panic attack symptoms are numerous and involve both mental and physical signs and symptoms. A panic attack can occur in other anxiety states such as agoraphobia and with certain activities and places. It may occur spontaneously without an apparent cause.
Parkinson's Disease: A chronic, slowly-progressing disease of the nervous system characterized clinically by the combination of tremor, rigidity, extreme slowness of movement, and stooped posture. It is characterized pathologically by loss of dopamine in the substantia nigra.
Refined Sugar: The term 'refined sugar' includes not only the “sugar” listed in ingredient listings, but also brown sugar, glucose, fructose and dextrose. Obvious sources include jams and jellies; hidden sources are often mayonnaise, ketchup, salad dressings and other condiments.
Schizophrenia: Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.
Seizure: While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.
Short-Term Memory: Also known as immediate memory or working memory, this is a phase of memory in which a limited amount of information may be held for several seconds to minutes. In general, up to 7 'chunks' of information are stored for about 20 seconds.
Sulfite Sensitivity: A person can develop sulfite sensitivity (allergy) at any point in their life but the cause is often unknown. Sulfites are sulfur-based compounds that are added by food manufacturers and restaurants for many purposes such as reducing discoloration of light-colored fruits and vegetables; preventing black spots on seafood; inhibiting the growth of microorganisms in fermented foods such as wine; conditioning dough; maintaining the stability and potency of certain medications. The most common symptom is difficulty in breathing. Sulfites give off the gas sulfur dioxide, which can cause irritation in the lungs and cause a severe asthma attack for those who suffer from asthma. Responses vary; sulfites can also cause chest tightness, nausea, hives, or even anaphylactic shock.
Urticaria: Commonly known as hives, urticaria is one of the most common dermatological conditions seen by allergists. Urticaria is not just an allergic disease, however. It can be caused by metabolic diseases, medications, infectious diseases, autoimmune disease, or physical sensitivity. Traditional allergi
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