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Intrusive Thoughts
Thank you for filling out this survey. All responses are anonymous. Please answer as truthfully as possible.
1.
What is your sex?
Male
Female
2.
What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
3.
Do you ever experience any of the following intrusive thoughts? By an intrusive thought/ image we mean an unwanted, distressing thought that can pop into your head without warning at anytime.
Falling downstairs
Leaving the stove on
Pushing a stranger infront of a car
Catching an STD from a toilet seat
Catching a fatal disease from strangers
Causing a public scene
Contamination from toilet doors
None of the above
Other (please specify)
4.
If you experience any intrusive thoughts what would you do?
5.
When looking after children do you experience any of the following thoughts/images?
Dropping the baby/ child down the stairs when carrying them
Falling down the stairs when carrying a baby/ child
Slipping on tiles when carrying a baby/ child whilst at a swimming pool
Pushing the pram in front of a busy road
Baby/ child suffocating in their sleep
Baby/ child choking whilst in your care
Hitting a baby too hard whilst winding them
Other (please specify)
None of the above
6.
If you experience any intrusive thoughts what would you do?
7.
When you experience any intrusive thoughts, what do you feel it says about you?