Internal Experiences Assessment

For each statement, select the response from the dropdown that best reflects how often it applies to your experience.

Never — This does not occur for you

Rarely — This occurs infrequently

Sometimes — This occurs occasionally

Often — This occurs regularly

Very Often — This occurs frequently or consistently

How frequently do you experience the following thoughts, feelings, or actions?

I believe I can care for my own needs.

I am afraid that people I care about may abandon me.

I experience urges to engage in behaviors that are harmful to me.

I often feel watchful or defensive.

I sometimes feel detached, as though I am observing myself from the outside.

I often feel vulnerable and unable to cope.

I become angry and lose control of my temper.

I dwell critically on things I have said or done.

During times of intense sadness or distress, I find some comfort in knowing suicide is an option.

I feel lively, happy, and full of energy.

I worry that people may reject me if I do not help or please them.

When I have urges to do something unhealthy, I stop to consider the possible outcomes.

I believe it is better to avoid getting too close to others.

I often feel separate from my physical self.

I often feel as though something is wrong with me emotionally.

I see my anger as something that keeps me safe from others.

I allow myself permission to make mistakes without harsh judgment.

I have thoughts about wanting to die.

When I become upset, I am able to soothe myself in constructive ways.

I try to figure out what others want from me so they will not become upset.

I act on impulse in ways that later create problems for me.

Trusting other people does not come easily to me.

I often feel mentally cloudy or unfocused.

I often feel emotionally wounded or down.

I struggle to manage my anger.

I judge myself very harshly.

When I am distressed, I have urges to injure myself.

I believe I can face difficulties with strength and bravery.

Rejection from someone important to me feels devastating.

I engage in behaviors I do not truly want to do, yet I feel unable to stop.

I keep my expectations of others low to protect myself from disappointment.

Under stress, I tend to feel detached or mentally absent.

I often feel discouraged and without hope.

I frequently feel annoyed, irritated, or angry.

Even when I am doing well, I feel it is still not enough.

I intentionally hurt myself to take attention away from emotional pain.

I trust my ability to handle whatever challenges arise.

If someone close to me leaves, I believe I will still be okay.

When I feel sad or distressed, I try to feel better through things like substances, sex, food, or spending.pdown

I believe that relaxing my defenses will put me at risk.

I feel connected to and aware of my body.

I feel as though I am coming undone.

I respond to my mistakes with kindness rather than harshness.

I feel unable to stop myself from self-harming.

I feel positive and hopeful about the future.

The thought of a breakup or separation makes me feel uneasy.

I try to avoid feeling hopeful so I will not be disappointed.

Emotional or physical pain can feel more than I can handle.

I speak to myself in a critical way.

I believe I am capable of achieving what I set out to do.

I feel panicked when someone important to me seems like they may leave.

Strong emotional experiences feel difficult for me to tolerate.

I often feel powerless and lacking strength.

When something painful happens, I am able to comfort myself.

I often feel alone and cut off from others.

At my core, I feel that something is fundamentally wrong with me.

I experience a feeling of calm within myself.

First name and last initial