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症状自评量表(SCL-90)

时间:2015-10-31 09:46 点击:

姓名           性别             年龄                  评定日期
   注意:以下表格中列出了有些人可能会有的问题,请仔细阅读每一条,然后根据最近一星期以内下述情况影响您的实际感觉,在5个方格中选择一格,划一个“√”。
                                                  没有  很轻  中等  偏重  严重
                                                   1     2     3     4     5
 1.头痛                                           □    □    □    □    □  1
 2.神经过敏,心中不踏实                           □    □    □    □    □  2
 3.头脑中有不必要的想法或字句盘旋                 □    □    □    □    □  3
 4.头昏或昏倒                                     □    □    □    □    □  4
 5.对异性的兴趣减退                               □    □    □    □    □  5
 6.对旁人责备求全                                 □    □    □    □    □  6
 7.感到别人能控制您的思想                         □    □    □    □    □  7
 8.责怪别人制造麻烦                               □    □    □    □    □  8
 9.忘记性大                                       □    □    □    □    □  9
10. 担心自己的衣饰整齐及仪态的端正                 □    □    □    □    □ 10
11.容易烦恼和激动                                 □    □    □    □    □ 11
12.胸痛                                           □    □    □    □    □ 12
13.害怕空旷的场所或街道                           □    □    □    □    □ 13
14.感到自己的精力下降,活动减慢                   □    □    □    □    □ 14
15.想结束自己的生命                               □    □    □    □    □ 15
16.听到旁人听不到的声音                           □    □    □    □    □ 16
17.发抖                                           □    □    □    □    □ 17
18.感到大多数入都不可信任                         □    □    □    □    □ 18
19.胃口不好                                       □    □    □    □    □ 19
20.容易哭泣                                       □    □    □    □    □ 20
21.同异性相处时感害羞不自在                       □    □    □    □    □ 21
22.感到受骗、中了圈套或有人想抓住您               □    □    □    □    □ 22
23.无缘无故地突然感到害怕                         □    □    □    □    □ 23
24.自己不能控制地大发脾气                         □    □    □    □    □ 24
25.怕单独出门                                     □    □    □    □    □ 25
26.经常责怪自己                                   □    □    □    □    □ 26
27.腰痛                                           □    □    □    □    □ 27
28.感到难以完成任务                               □    □    □    □    □ 28
29.感到孤独                                       □    □    □    □    □ 29
30.感到苦闷                                       □    □    □    □    □ 30
31.过分担忧                                       □    □    □    □    □ 31
32.对事物不感兴趣                                 □    □    □    □    □ 32
33.感到害怕                                       □    □    □    □    □ 33
34.我的感情容易受到伤害                           □    □    □    □    □ 34
35.旁人能知道您的想法                             □    □    □    □    □ 35
36.感到别人不理解                                 □    □    □    □    □ 36
37.感到人们对您不友好,不喜欢您                   □    □    □    □    □ 37
38.做事必须做得很慢以保证做得正确                 □    □    □    □    □ 38
39.心跳得很厉害                                   □    □    □    □    □ 39
40.恶心或胃部不舒服                               □    □    □    □    □ 40
41.感到比不上他人                                 □    □    □    □    □ 41
42.肌肉酸痛                                       □    □    □    □    □ 42
43.感到有人在监视您谈论您                         □    □    □    □    □ 43
没有  很轻  中等  偏重  严重 
                                                   1     2     3     4     5
44.难以入睡                                       □    □    □    □    □ 44
45.做事必须反复检查                               □    □    □    □    □ 45
46.难以作出决定                                   □    □    □    □    □ 46
47.怕乘电车、公共汽车、地铁或火车                 □    □    □    □    □ 47 
48.呼吸有困难                                     □    □    □    □    □ 48
49,一阵阵发冷或发热                               □    □    □    □    □ 49
50.因为感到害怕而避开某些东西、场合或活动         □    □    □    □    □ 50
51.脑子变空了                                     □    □    □    □    □ 51
52.身体发麻或刺痛                                 □    □    □    □    □ 52
53.喉咙有梗塞感                                   □    □    □    □    □ 53
54.感到前途没有希望                               □    □    □    □    □ 54
55.不能集中注意                                   □    □    □    □    □ 55
56.感到身体的某一部分软弱无力                     □    □    □    □    □ 56
57.感到紧张或容易紧张                             □    □    □    □    □ 57
58.感到手或脚发重                                 □    □    □    □    □ 58
59.想到死亡的事                                   □    □    □    □    □ 59
60.吃得太多                                       □    □    □    □    □ 60
61.当别人看着您或谈论您时感到不自在               □    □    □    □    □ 61
62.有一些不属于您自己的想法                       □    □    □    □    □ 62
63.有想打人或伤害他人的冲动                       □    □    □    □    □ 63
64.醒得太早                                       □    □    □    □    □ 64
65.必须反复洗手,点数目或触摸某些东西             □    □    □    □    □ 65
66.睡得不稳不深                                   □    □    □    □    □ 66
67.有想摔坏或破坏东西的冲动                       □    □    □    □    □ 67
68.有一些别人没有的想法或念头                     □    □    □    □    □ 68
69.感到对别人神经过敏                             □    □    □    □    □ 69
70.在商店或电影院等人多的地方感到不自在           □    □    □    □    □ 70
71.感到任何事情都很困难                           □    □    □    □    □ 71
72.一阵阵恐惧或惊恐                               □    □    □    □    □ 72
73.感到在公共场合吃东西很不舒服                   □    □    □    □    □ 73
74.经常与人争论                                   □    □    □    □    □ 74
75.单独一人时神经很紧张                           □    □    □    □    □ 75
76.别人对您的成绩没有作出恰当的评价               □    □    □    □    □ 76
77.即使和别人在一起也感到孤单                     □    □    □    □    □ 77
78.感到坐立不安心神不定                           □    □    □    □    □ 78
79.感到自己没有什么价值                           □    □    □    □    □ 79
80.感到熟悉的东西变成陌生或不象是真的             □    □    □    □    □ 80
81.大叫或摔东西                                   □    □    □    □    □ 81
82.害怕会在公共场合昏倒                           □    □    □    □    □ 82
83.感到别人想占您的便宜                           □    □    □    □    □ 83
84.为一些有关“性”的想法而很苦恼                 □    □    □    □    □ 84
85.您认为应该因为自己的过错而受到惩罚             □    □    □    □    □ 85
86.感到要赶快把事情做完                           □    □    □    □    □ 86
87.感到自己的身体有严重问题                       □    □    □    □    □ 87
88.从未感到和其他人很亲近                         □    □    □    □    □ 88
89.感到自己有罪                                   □    □    □    □    □ 89
9O.感到自己的脑子有毛病                           □    □    □    □    □ 90
 
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