1. |
| Stressful events occurring that affect well-being |
2. |
| I drive myself to exhaustion |
3. |
| Work and overwork with little time for recreation, vacation |
4. |
| Weight gain around the middle |
5. |
| Frequent upper respiratory infections |
6. |
| In the past 10 years, have taken Rx steroids for more than 10 days |
7. |
| History, or current, excessive alcohol or recreational drug use |
8. |
| Sensitive to perfumes, gasoline, dust, mold, pollens |
9. |
| Been diagnosed with a chronic, or autoimmune, disease |
10. |
| Have post-traumatic stress syndrome |
11. |
| Decreased cognitive ability, not thinking as clearly |
12. |
| Get shaky when angry or am under stress |
13. |
| Chronically fatigued |
14. |
| Need to lie down and rest frequently |
15. |
| Can feel weak all over, "the plug gets pulled" |
16. |
| Hard to arise in the morning and feel better after 3-4 hours |
17. |
| History or current, asthma; reactive airway, respiratory allergies |
18. |
| Require coffee to get the day started |
19. |
| Crave salt |
20. |
| Unhappy relationships affect my "joy" |
