The purpose of this study is to gain an understanding of thoughts and beliefs and how those thoughts and beliefs manifest themselves. You must be at least 18 years of age to participate in this survey.
Some of the questions are very personal, but this survey is completely anonymous and your identifying information will neither be collected nor reported. You can stop this survey at any time if you do not feel comfortable.
For more information please email anne.whitney@northwestu.edu
Anne Whitney, MAc
Northwest University
Kirkland, WA
USA

* 1. Age?

* 2. Sex?

* 3. Please indicate how strongly the following statements have suited you -throughout your lifetime-.

  Not at all Rarely Sometimes Often Very often
I have felt undesirable to others.
I view myself as a failure because often I don't live up to my expectations.
I have trusted people.
I think I will fail at everything I try.
I have believed that no one will ever meet my needs for nurturance, affection and caring.
I have felt very afraid that something bad will happen to me.
I have felt ashamed of my own inadequacies.
I have been afraid of being abandoned.
I have found myself sacrificing my own needs to satisfy other people's needs.
I have felt afraid that I would be unlovable if people got to know me.
I have been unwilling to let anyone get in the way of what I want.
I have expected others to misuse, abuse or hurt me.
I have felt self confident.
I have thought I'm a bad person, deserving to be punished.
I have felt like an island, isolated from everyone else.
I have felt like I needed too much support from friends and family.
I have found myself afraid of losing control of my behavior.

* 4. Please indicate how strongly the following words describe your mother (or mother figure).

  Not at all Rarely Sometimes Often Very Often N/A No mother/mother figure
Dependent
Easygoing
High Expectations
Controlling
Kind
Predictable
Overprotective
Distant
Needy
Dependable
Creative
Idealistic
Demeaning
Hostile

* 5. Please indicate how strongly the following words describe your father or father figure.

  Not at all Rarely Sometimes Often Very Often N/A No father/father figure
Idealistic
Hostile
Creative
Needy
Predictable
Dependable
Distant
Dependent
High Expectations
Easygoing
Demeaning
Controlling
Kind
Overprotective

* 6. Have you at some point been diagnosed with schizophrenia? (If no, skip to the end).

* 7. How old were you when you first experienced symptoms of schizophrenia?

* 8. Can you please describe any significant events that occurred just before you started having symptoms? (moves, breakups, deaths in the family, etc).

* 9. Have you had, at some point, any recurring themes in your symptoms? If so, can you describe them and what they mean to you?

Thank you for participating! A summary of the results from this study will be provided on www.schizophrenia.com at the conclusion of the study.

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