Name BSI18 iNeed Brief Symptom Inventory 18S" ———_ se Scored By {eonard R- Derogatis, PAD INSTRUCTIONS: Below is a list of problems people sometimes have. Read each one carefully and fill in the circie that best describes HOW MUCH THAT PROBLEM HAS DISTRESSED OR BOTHERED YOU DURING THE PAST 7 DAYS INCLUDING TODAY. Blacken the circle for only one number for each problem. Do not skip any items. If you change your mind, erase your first mark carefully and then fill in your new choice. Read the example before beginning. If yau have any questions, please ask them now. wy EXAMPLE 1jo ole @ | « [Bodyaches CSM8/8/ $/ 8 CLI S/S 8) BEE VE, HOW MUCH WERE YOU DISTRESSED BY: Lao 1! @| ©] ©| ©] @ [Faintness or dizziness 2] ©| ©| ©| ©] © [Feeling no interest in things 31 ©] © | ©| ©| @ | Nervousness or shakiness inside = 4] @| ©| ©| ©| © | Pains in heart or chest _ 5] ©| ©] ®| | @ [Feeling lonely A a ©] ©] ©| ©| ©| © | Feeting tense or keyed up . 71 @| ©| ©| ©] @ | Nausea or upset stomach _ &) © O| ©| ©| @ [Feeling bue © ~ 2] ©] @| @| ©] @ [Suddenly scared for no reason = ©] ©] ©] ©| ©| @ | Trouble cetting your breath _ 11 @©| ©] ©| @| @ | Feelings of worthlessness 2) ©] ©] ©| ©| @ |Spetis of terror or panic - 13! © | © | © | © | © | Numbness or tingling in parts of your body =< 141 ©| ©| ©| ©| @ | Feeling hopeless about the future . 151 ©| ©] ©| ©| @ | Feeling so restless you couldn't sit stil = 16 | ©| @| ©| © | @ | Feeting weak in parts of your body _ 17| @| @| ©| ©] @ | Thoughts of ending your lite o 18) @| 0] ©| ©| © |Feeting teal . me a Product Number