First Name
Age Group
Zip Code
Marital Status
How many people share the living space with you?
What is your highest level of formal education?
High School
What race/ethnicity do you belong to?
What is the frequency of your visits to the health care provider?
Are you presently employed? If yes, what is your occupation?
Were you employed previously? If yes, when and where?
What conditions have you been diagnosed with? When? Where?
Obsessive-Compulsive Disorder. I was diagnosed in May 2004 in China but suffered from it for four years.
Have you ever been hospitalized? If yes, how many times? When was the last time that you were hospitalized?
Please describe everything you know about your condition(s) and how you obtained such information?
Well, I can write a book to describe everything. I'm an OCD expert. Internet is where i obtained all those infos.
Please illustrate your life before, during, and after learning of your condition(s) and engaging in therapies, if any?
I never engage in any therapy.
Please describe how you cope with your condition(s), if at all, and the effectiveness of each strategy?
Reading Self-help books, joining online OCD communities, read online-articles regarding OCD.
Does the state of your health impede in any way your everyday activities such as work, housework, studies and so on?
Does the state of your health impede in any way your social activities, such as inviting others to your residence, accepting invitations, going out with friends and so on?
Yes, very much so!
How would you classify your daily interactions with people in general? (Comfortable, neutral, awkward, unpleasant) Please describe in detail.
Well, it depends. When OCD thoughts attack me, it's extrememly unpleasant, otherwise it's quite comfortable.
How do you envision your future?
Great! I'm the future Nobel Prize Winner. (Oh, i'm very ambitious despite my mental illness)
On the whole, I am satisfied with myself.
Strongly Disagree
At times I think I am no good at all.
I feel that I have a number of good qualities.
Strongly Agree
I am able to do things as well as most other people.
I feel I do not have much to be proud of.
Strongly Disagree
I certainly feel useless at times.
Strongly Disagree
I feel that I'm a person of worth, at least on an equal plane with others.
Strongly Agree
I wish I could have more respect for myself.
Strongly Disagree
All in all, I am inclined to feel that I am a failure.
I take a positive attitude toward myself.
Strongly Agree
I can always manage to solve difficult problems if I try hard enough.
Strongly Disagree
If someone opposes me, I can find the ways and means to get what I want.
Strongly Disagree
I am certain that I can accomplish my goals.
Strongly Disagree
I am confident that I could deal efficiently with unexpected events.
Thanks to my resourcefulness, I can handle unforeseen situations.
Strongly Disagree
I can solve most problems if I invest the necessary effort.
Strongly Disagree
I can remain calm when facing difficulties because I can rely on my coping abilities.
When I am confronted with a problem, I can find several solutions.
Strongly Disagree
If I am in trouble, I can think of a good solution.
Strongly Disagree
I can handle whatever comes my way.
With my illness experience, I feel I am:
Almost always tense
Almost always uncomfortable
Almost always in agony
Almost always distraught
More often optimistic
More often confident
Almost always helpless
Almost always certain
My relationships help me feel I am:
Almost always valued
Almost always comforted
Almost always close
Almost always connected
Almost always included
Almost always supported
Almost always accepted
Towards those who are emotionally close to me, I feel I am:
Equally forgiving and resentful
Almost always welcoming
Almost always accepting
Almost always encouraging
Almost always trusting
Almost always understanding
Almost always respectful
Universal beliefs and principles or a divine presence help me feel I am:
Almost always inspired
Almost always comforted
Almost always accepted
Almost always guided
Almost always embraced
Almost always out-of-step
Equally sustained and adrift
Towards universal beliefs and principles or a divine presence I feel I am:
Almost always listening
Almost always receptive
Equally thankful and demanding
More often critical
More often approaching
Equally willing and resisting
Almost always connecting