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. 2012 Apr 19;38(6):1288–1296. doi: 10.1093/schbul/sbs068
If TRUE: how much distress did you experience?
No Mild Moderate Severe
1. I feel uninterested in the things I used to enjoy. □ True □ False 0 1 2 3
2. I often seem to live through events exactly as they happened before (déjà vu). □ True □ False 0 1 2 3
3. I sometimes smell or taste things that other people can’t smell or taste. □ True □ False 0 1 2 3
4. I often hear unusual sounds like banging, clicking, hissing, clapping or ringing in my ears. □ True □ False 0 1 2 3
5. I have been confused at times whether something I experienced was real or imaginary. □ True □ False 0 1 2 3
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 1 2 3
7. I get extremely anxious when meeting people for the first time. □ True □ False 0 1 2 3
8. I have seen things that other people apparently can't see. □ True □ False 0 1 2 3
9. My thoughts are sometimes so strong that I can almost hear them. □ True □ False 0 1 2 3
10. I sometimes see special meanings in advertisements, shop windows, or in the way things are arranged around me. □ True □ False 0 1 2 3
11. Sometimes I have felt that I’m not in control of my own ideas or thoughts. □ True □ False 0 1 2 3
12. Sometimes I feel suddenly distracted by distant sounds that I am not normally aware of. □ True □ False 0 1 2 3
13. I have heard things other people can't hear like voices of people whispering or talking. □ True □ False 0 1 2 3
14. I often feel that others have it in for me. □ True □ False 0 1 2 3
15. I have had the sense that some person or force is around me, even though I could not see anyone. □ True □ False 0 1 2 3
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 1 2 3