Thank you so much for your time and willingness to help us learn more about being emotionally
sensitive. Please note that there are a few general questions about abuse, suicide and self-harm. If
those questions might upset you, please do not answer the survey or be sure you are with people who
support you. Your well-being is most important.

* 1. I am

* 2. My relationship status is

* 3. My age is

* 4. My highest level of education is

* 5. I was physically bullied when I was in school.

* 6. I hide my emotionally sensitivity so well that other people would be surprised to learn how sensitive I am.

* 7. Overeating is a primary way I soothe or comfort myself when upset.

* 8. I often feel that I am flawed as a human being because of my intense emotions.

* 9. I am more uncomfortable than most when others make positive statements about my character.

* 10. I am more uncomfortable than most when others compliment my sklls or talents.

* 11. I engage in self-harm

* 12. I have a pet that is dear to me.

* 13. When I was growing up, "negative" emotions were not accepted in my family.

* 14. When I was growing up, positive emotions were not accepted in my family.

* 15. My parents or caregivers suffered with problems with alcohol and/or other substance use.

* 16. People often tell me I am too controlling.

* 17. What fact have you learned or experience have you had that has helped you accept being emotionally
sensitive?

* 18. The main reason I hold back in relationships is

* 19. I consider myself a good problem solver.

* 20. When a situation gets difficult, I tend to quit, withdraw, or leave to get out of the situaton.

* 21. I believe I feel more connected to the people of the world than less emotionally sensitive
people do.

* 22. I am most content when I am

* 23. I believe I am very clear about who I am.

* 24. If my family understood what it means to be emotionally sensitive, my life would be easier.

* 25. I have a history of being abused as a child.

* 26. I act on my emotions without thinking through the consequences

* 27. I think of suicide

* 28. I feel joy as intensely as I feel anger and sadness.

* 29. I am afraid of my emotions.

* 30. I do not let myself grieve when I have lost someone or something important to me.

* 31. I think most other people are happy all the time.

* 32. Do you have any habits or obsessions that you think are unusual?

* 33. I have a history of trauma other than or in addition to childhood abuse/neglect.

* 34. I avoid solving problems or thinking about problems.

* 35. The one change that would give me the life that I want would be

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