1. |
I feel uninterested in the things I used to enjoy. |
□ True □ False |
□ 0
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□ 1
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2. |
I often seem to live through events exactly as they happened before (déjà vu). |
□ True □ False |
□ 0
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□ 1
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□ 2
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3. |
I sometimes smell or taste things that other people can’t smell or taste. |
□ True □ False |
□ 0
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□ 1
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□ 2
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4. |
I often hear unusual sounds like banging, clicking, hissing, clapping or ringing in my ears. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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5. |
I have been confused at times whether something I experienced was real or imaginary. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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6. |
When I look at a person, or look at myself in a mirror, I have seen the face change right before my eyes. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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7. |
I get extremely anxious when meeting people for the first time. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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8. |
I have seen things that other people apparently can't see. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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9. |
My thoughts are sometimes so strong that I can almost hear them. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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10. |
I sometimes see special meanings in advertisements, shop windows, or in the way things are arranged around me. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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11. |
Sometimes I have felt that I’m not in control of my own ideas or thoughts. |
□ True □ False |
□ 0
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□ 1
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□ 2
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12. |
Sometimes I feel suddenly distracted by distant sounds that I am not normally aware of. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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13. |
I have heard things other people can't hear like voices of people whispering or talking. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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14. |
I often feel that others have it in for me. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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15. |
I have had the sense that some person or force is around me, even though I could not see anyone. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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16. |
I feel that parts of my body have changed in some way, or that parts of my body are working differently than before. |
□ True □ False |
□ 0
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□ 1
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□ 2
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□ 3
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