1) I rely on the opinion of others to make
decisions.

2) I am very fearful of criticism, disapproval,
or rejection.

3) At times I get so anxious or upset that I experience most of the following: heart racing or pounding, sweating; tearfulness; blushing; difficulty swallowing or lump in my throat; shaking; poor concentration dizziness, nausea or diarrhea; butterflies.

4) I often find myself angry or hurt by the
behavior and words of others

5) I feel too embarrassed to eat out alone or
to attend movies and other activities by
myself.

6) I tend to be a perfectionist, needing to
look perfect and to do things perfectly.

7) I often avoid situations where I think I will
be uncomfortable

8) I think life is harder for me than for most
other people.

9) I grew up in a dysfunctional home.

10) I am not very aware of my feelings.

11) I am easily discouraged.

12) I do not set goals for the future.

13) I’m fearful that I will say or do something
that will make me look stupid or
incompetent

14) I sometimes lie when I feel that the truth
would result in criticism or rejection

15) I often refrain from sharing my opinions,
my ideas, and my feelings in groups.

16) I often think that others don’t respect me.

17) I often make decisions on the basis of
what would please others rather than on
what I want or without even considering
what I want.

18) At night, I frequently review my day,
analyzing what I said and did or what
others said and did to me that day

19) I often feel that others mistreat me and or
take advantage of me

20) I frequently think negative thoughts
about myself and others.

21) I often compare myself to others

22) I often feel like I don’t know what is
expected of me.

23) I often feel like I don’t know what is
expected of me.

24) I tend to think that I have higher standards
than others.

25) I felt inferior or inadequate as a child.

26) I try to avoid conflict and confrontation

27) I often procrastinate.

28) I often get so anxious that I don’t know
what to say.

29) I’m one of the following: The person who
reveals too much personal information
about myself or the person who seldom
reveals personal information.

30) I have found it difficult to perform
adequately or without embarrassment
when involved in sex

31) I tend to think negatively much of the time.

32) I tend to let fear and anxiety control many
of my decisions

33) I have not accomplished what I am
capable of due to fear and avoidance.

34) I often get defensive and strike back when
I perceive I am being criticized.

35) I have avoided making changes in my life
because I was fearful of making a mistake
or failing.

36) I often feel depressed about things I’ve said
and done, or things I failed to say or do.

37) I fear making a mistake which others
might see.

38) I think others are very focused on—and
critical of—what I say and do

39) I am easily embarrassed

40) I am very concerned about my
appearance

41) I often feel like I don’t know the right
thing to do or say.

42) I have difficulty knowing who to trust and
when to trust

43) When someone mistreats me I think that I must have done something to deserve it.

44) I am anxious and fearful much of the time.

45) I have periods in which I feel devastated and/or depressed.

46) I am very critical of myself and others.

47) I tend to magnify my mistakes and minimize my successes.

48) _ I fear being made to look like a fool.

49) I find it difficult to hear criticism about
myself

50) I generally feel anxious in new social
situations where I may not know what is
expected of me