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Have you ever walked in your sleep during
your adult life?

yesno

As a teenager, did you feel comfortable expressing your feelings
to one or both of your parents?

yesno

Do you have a tendency to look directly into people’s eyes
and/or move closely to them when discussing an interesting subject?

yesno

Do you feel that most people you meet for the first time are
uncritical of your appearance?

yesno

In a group situation with people you have just met, would you
feel comfortable drawing attention to yourself by initiating a
conversation?

yesno

Do you feel comfortable holding hands or hugging someone you are
in a relationship with while other people are present?

yesno

When someone talks about feeling warm physically, do you begin
to feel warm also?

yesno

Do you occasionally have a tendency to tune out when someone is
talking to you, and at times not even hear what the other person is saying,
because you are anxious to come up with your side of it?

yesno

Do you feel that you learn and comprehend better by seeing
and/or reading than by hearing?

yesno

In a new class or lecture situation, do you usually feel
comfortable asking questions in front of the group?

yesno

When expressing your ideas, do you find it important to relate
all the details leading up to the subject so the other person can understand it
completely?

yesno

Do you enjoy relating to children?

yesno

Do you find it easy to be at ease and comfortable with your body
movements, even when faced with unfamiliar people and circumstances?

yesno

Do you prefer reading fiction rather than non-fiction?

yesno

If you were to imagine sucking on a sour, bitter, juicy, yellow
lemon, would your mouth water?

yesno

If you feel that you deserve to be complimented for something
well done, do you feel comfortable if the compliment is given to you in front of
other people?

yesno

Do you feel that you are a good conversationalist?

yesno

Do you feel comfortable when complimentary attention is drawn to
your physical body or appearance?

yesno

Have you ever awakened in the middle of the night and felt that
you could not move your body and/or could not talk?

yesno

As a child, did you feel that you were more affected by the tone
of voice of your parents than by what they actually said?

yesno

If someone you are associated with talks about a fear that you
too have experienced, do you have a tendency to have an apprehensive or fearful
feeling also?

yesno

If you are involved in an argument with someone, after the
argument is over do you have the tendency to dwell on what you could or should
have said?

yesno

Do you have a tendency to tune out occasionally when someone is
talking to you – perhaps not even hear what was said – because your mind has
drifted to something totally unrelated?

yesno

Do you sometimes desire to be complimented for a job well done,
but feel embarrassed or uncomfortable when complimented?

yesno

Do you often have a fear or dread of not being able to carry on
a conversation with someone you have just met?

yesno

Do you feel self-conscious when attention is drawn to your
physical body or appearance?

yesno

If you have your choice, would you rather avoid being around
children most of the time?

yesno

Do you feel that you are not relaxed or loose in body movements,
especially when faced with unfamiliar people or circumstances?

yesno

Do you prefer reading non-fiction rather than fiction?

yesno

If someone describes a very bitter taste, do you have difficulty
experiencing the physical feeling of it?

yesno

Do you generally feel that you see yourself less favourable than
others see you?

yesno

Do you tend to feel awkward or self-conscious initiating touch
(holding hands, kissing, etc.) with someone you are in a relationship with while
other people are present?

yesno

In a new class or lecture situation do you usually feel
uncomfortable asking questions in front of the group even though you desire
further explanation?

yesno

Do you feel uneasy if someone you have just met looks you
directly in the eyes when talking to you, especially if the conversation is about
you?

yesno

In a group situation with people you have just met, would you
feel uncomfortable drawing attention to yourself by initiating a
conversation?

yesno

If you are in a relationship or are very close to someone, do
you find it difficult or embarrassing to verbalize your love for him or
her?

yesno