| _____ Feeling nervous or anxious |
_____ Use/abuse of alcohol and/or drugs |
| _____ Feelings of Panic |
_____ Difficulty with school or work |
| _____ Under pressure and feeling stressed |
_____ Concerns about finances |
_____ Needing to learn to relax
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_____ Having difficulty being honest/open |
| _____ Afraid of being on your own |
_____ Having difficulty communicating |
| _____ Feeling angry much of the time |
_____ Having a hard time making friends |
| _____ Concerns about your violence |
_____ Having a hard time keeping friends |
| _____ Difficulty expressing emotions |
_____ Wishing you were more social |
| _____ Feeling inferior to others |
_____ Feeling pressured by others |
| _____ Lacking in self-confidence |
_____ Feeling controlled/manipulated |
| _____ Feeling down or unhappy |
_____ Marital or couple problems |
| _____ Feeling lonely and/or isolated |
_____ Family difficulties |
| _____ Guilty feelings |
_____ Difficulties with children |
| _____ Feeling down on yourself |
_____ Break-up of a relationship |
| _____ Thoughts of taking your own life |
_____ Difficulties in sexual relationships |
| _____ Recent trauma or loss in your life |
_____ Feeling guilty about sexual activities |
| _____ Concerns about emotional stability |
_____ Feelings related to molestation or rape |
| _____ Feeling cut off from your emotions |
_____ Concerns about childhood abuse |
| _____ Wondering “Who I am” |
_____ Concerns about your weight |
_____ Difficulty making decisions
|
_____ Difficulties with weight control |
| _____ Feeling confused much of the time |
_____ Concerns about your physical health |
| _____ Difficulty controlling your thoughts |
_____ Concerns about your appearance |
| _____ Difficulty controlling your actions |
_____ Performing ritualistic behaviors |
| _____ Being suspicious of others |
_____ Fear of losing control |
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