The quiz below is designed only to give you a generalized idea of your emotional health.
You may fill this form out and print it to bring with you to your session at Wisconsin Community Mental Health Counseling
Centers or, if you prefer, this document is provided in downloadable Portable Document Format (PDF) by
clicking here. The Adobe Reader or equivalent PDF viewer is required and can be downloaded free of charge
at www.adobe.com. If you have any questions regarding this quiz please contact us at
262.242.3810.
Question
Rarely or Never
Sometimes
Often or A Lot
Emotionally, I am not doing well.
I am not satisfied with my life
I feel unhappy, sad, or depressed.
I am less interested in things I used to enjoy.
I feel intense fear or anxiety without knowing why.
I cannot relax.
I am afraid that something bad is going to happen.
I have been criticized for my drinking or drug use.
I feel guilty about my drinking or drug use.
I have tried to cut down on my drinking or drug use.
I am easily irritated or annoyed.
I feel out of control of my anger.
I feel afraid of someone else.
I have rapid or strong emotional swings.
I have racing thoughts.
I have thoughts or ideas that other might find unusual or odd.
I am worried that there is something wrong with my mind.
I cannot control how much I eat.
I can go to extreme measures to avoid gaining weight.
Emotional problems or difficulties may interfere with my relationships.
I am accomplishing less than usual at work or school because of emotional problems or difficulties.
