Problem Checklist

PROBLEM CHECKLIST
Individual Problem Checklist

Emotional Concerns

feeling anxious or uptight
excessive worrying
not being able to relax
feeling panicky
unable to calm yourself down
dwelling on certain thoughts or images
fearing something terrible about to happen
avoiding certain thoughts or feelings
having strong fears
worrying about a nervous breakdown
feeling out of control
avoiding being with people
fears of being alone or abandoned
feeling guilty
having nightmares
flashbacks
troubling or painful memories
missing periods of time - can't remember
trouble remembering things
feeling numb instead of upset
feeling unreal, strange or foggy
feeling depressed or sad
being tired or lacking energy
feeling unmotivated
loss of interest in many things
having trouble concentrating
having trouble making decisions
feeling the future looks hopeless
feeling worthless or a failure
being unhappy all the time
dissatisfied with physical appearance
feeling self critical or blaming yourself
having negative thoughts
crying often
feeling empty
withdrawing inside yourself
thinking too much about death
thoughts of hurting yourself
thoughts of killing yourself
frequent mood swings
feeling resentful or angry
feeling irritable or frustrated
feeling rage
feeling like hurting someone

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Behavioral and Physical Concerns

not having an appetite
eating in binges
self induced vomiting for weight control
using laxatives for weight control
eating too much
eating too little
losing weight
gaining weight
trouble sleeping
trouble falling asleep
early morning awakening
sleeping too much
sleeping too little
lack of exercise
not having leisure activities
smoking cigarettes
temper outbursts
aggressive toward others
impulsive reactions
trouble finishing things
working too hard
using alcohol too much
being alcoholic
using drugs
driving under the influence
blackouts - after drinking

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Intimate Relationship Concerns

feeling misunderstood in relationship
not feeling close to partner
trouble communicating with partner
not trusting partner
lack of respect by partner
partner being secretive
lack of fairness in relationship
problems with dividing household tasks
disagreeing about children
lack of affection
unsatisfactory sexual relationship
lack of time together
lack of shared interests
jealousy in relationship
frequent arguments
trouble resolving conflict
partner being demanding and controlling
partner putting you down
violent arguments
emotional abuse in relationship
physical abuse in relationship
sexual abuse in relationship
partner having alcohol or drug problem
self or partner having an affair
feeling uncommitted to relationship
wanting to separate
discussing separating or divorce
problems with in-laws
problems with ex-partner
problems with step parents
children having special problems

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Sexual Concerns

worrying about getting pregnant
having miscarriage(s)
choice of birth control
having an abortion
not able to become pregnant
not enjoying sexual affection
too tired to have sex
too anxious to have sex
feeling a lack of sexual desire
wanting to have sex more often
feeling neglected sexually
feeling used sexually
feeling unable to have orgasm
being unable to sustain an erection
feeling negatively about sex
When Growing Up to Present Time:
being physically abused - by whom?
being emotionally abused - by whom?
being sexually abused - by whom?
having an alcoholic parent - which?
having a drug abusing parent - which?
having a depressed parent - which?
having a parent with emotional problems
having parents separate or divorce
close family member dying - who?
felt neglected or unloved - by whom
having an unhappy childhood
having serious medical problems
having learning problems
having emotional problems
having attempted suicide - when?