NICHD SECCYDWisconsin

ADULT ATTACHMENT SCALE

Please read each of the following statements and rate the extent to which it describes your
feelings about close relationships in general. That is, we want you to think about how you feel in
all close relationships including your romantic relationships, friendships, and family
relationships. Please use the scale below and indicate the degree to which each statement is
characteristic of you by placing a number between 1 and 5 in the space provided to the right of
each statement.
1----------2----------3----------4----------5
Not at all
Very
characteristic
characteristic
1.

I find it relatively easy to get close to others.

_____

2.

I do not often worry about being abandoned.

_____

3.

I find it difficult to allow myself to depend on others.

_____

4.

People are never there when you need them.

_____

5.

In relationships, I often worry that others do not really love me.

_____

6.

I find that others are reluctant to get as close as I would like.

_____

7.

I am comfortable depending on others.

_____

8.

I do not often worry about someone getting too close to me.

_____

9.

I am somewhat uncomfortable being close to others.

_____

10.

I am nervous when anyone gets too close.

_____

11.

In relationships, I often worry that others will not want to stay with me.

_____

12.

I want to merge completely with another person.

_____

13.

My desire to merge sometimes scares people away.

_____

14.

I am comfortable having others depend on me.

_____

15.

I know that others will be there when I need them.

_____

16.

I find it difficult to trust others completely.

_____

17.

Often, people want me to be closer than I feel comfortable being.

_____

18.

I am not sure that I can always depend on others to be there when I need them.

_____

Beck's Depression Inventory

This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.
1.
0
I do not feel sad.
I feel sad
1
2
I am sad all the time and I can't snap out of it.
3
I am so sad and unhappy that I can't stand it.
2.
0
I am not particularly discouraged about the future.
1
I feel discouraged about the future.
2
I feel I have nothing to look forward to.
3
I feel the future is hopeless and that things cannot improve.
3.
0
I do not feel like a failure.
1
I feel I have failed more than the average person.
2
As I look back on my life, all I can see is a lot of failures.
3
I feel I am a complete failure as a person.
4.
0
I get as much satisfaction out of things as I used to.
1
I don't enjoy things the way I used to.
2
I don't get real satisfaction out of anything anymore.
3
I am dissatisfied or bored with everything.
5.
0
I don't feel particularly guilty
1
I feel guilty a good part of the time.
2
I feel quite guilty most of the time.
3
I feel guilty all of the time.
6.
0
I don't feel I am being punished.
1
I feel I may be punished.
2
I expect to be punished.
3
I feel I am being punished.
7.
0
I don't feel disappointed in myself.
1
I am disappointed in myself.
2
I am disgusted with myself.
3
I hate myself.
8.
I don't feel I am any worse than anybody else.
0
1
I am critical of myself for my weaknesses or mistakes.
2
I blame myself all the time for my faults.
3
I blame myself for everything bad that happens.
9.
0
I don't have any thoughts of killing myself.
1
I have thoughts of killing myself, but I would not carry them out.
2
I would like to kill myself.
3
I would kill myself if I had the chance.
10.
0
I don't cry any more than usual.
1
I cry more now than I used to.
2
I cry all the time now.
3
I used to be able to cry, but now I can't cry even though I want to.

11.

12.

13.

14.

15.

16.

17.

18.

19.

0
1
2
3

I am no more irritated by things than I ever was.

I am slightly more irritated now than usual.
I am quite annoyed or irritated a good deal of the time.
I feel irritated all the time.

0
1
2
3

I have not lost interest in other people.

I am less interested in other people than I used to be.
I have lost most of my interest in other people.
I have lost all of my interest in other people.

0
1
2
3

I make decisions about as well as I ever could.

I put off making decisions more than I used to.
I have greater difficulty in making decisions more than I used to.
I can't make decisions at all anymore.

0
1
2
3

I don't feel that I look any worse than I used to.

I am worried that I am looking old or unattractive.
I feel there are permanent changes in my appearance that make me look
unattractive
I believe that I look ugly.

0
1
2
3

I can work about as well as before.

It takes an extra effort to get started at doing something.
I have to push myself very hard to do anything.
I can't do any work at all.

0
1
2
3

I can sleep as well as usual.

I don't sleep as well as I used to.
I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
I wake up several hours earlier than I used to and cannot get back to sleep.

0
1
2
3

I don't get more tired than usual.

I get tired more easily than I used to.
I get tired from doing almost anything.
I am too tired to do anything.

0
1
2
3

My appetite is no worse than usual.

My appetite is not as good as it used to be.
My appetite is much worse now.
I have no appetite at all anymore.

0
1
2
3

I haven't lost much weight, if any, lately.

I have lost more than five pounds.
I have lost more than ten pounds.
I have lost more than fifteen pounds.

20.

21.

0
1
2
3

I am no more worried about my health than usual.

I am worried about physical problems like aches, pains, upset stomach, or
constipation.
I am very worried about physical problems and it's hard to think of much else.
I am so worried about my physical problems that I cannot think of anything else.

0
1
2
3

I have not noticed any recent change in my interest in sex.

I am less interested in sex than I used to be.
I have almost no interest in sex.
I have lost interest in sex completely.

INTERPRETING THE BECK DEPRESSION INVENTORY

Now that you have completed the questionnaire, add up the score for each of the twenty-one
questions by counting the number to the right of each question you marked. The highest possible
total for the whole test would be sixty-three. This would mean you circled number three on all
twenty-one questions. Since the lowest possible score for each question is zero, the lowest
possible score for the test would be zero. This would mean you circles zero on each question.
You can evaluate your depression according to the Table below.
Total Score____________________Levels of Depression
1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression

Beck Anxiety Inventory 1

Beck Anxiety Inventory

Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you
have been bothered by that symptom during the past month, including today, by circling the number in the
corresponding space in the column next to each symptom.

Not At All

Numbness or tingling
Feeling hot
Wobbliness in legs
Unable to relax
Fear of worst
happening
Dizzy or lightheaded
Heart pounding/racing
Unsteady
Terrified or afraid
Nervous
Feeling of choking
Hands trembling
Shaky / unsteady
Fear of losing control
Difficulty in breathing
Fear of dying
Scared
Indigestion
Faint / lightheaded
Face flushed
Hot/cold sweats
Column Sum

Mildly but it
didnt bother me
much.

Moderately - it
wasnt pleasant at
times

Severely it
bothered me a lot

0
0
0
0
0

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3

Scoring - Sum each column. Then sum the column totals to achieve a grand score. Write that
score here ____________ .
Interpretation
A grand sum between 0 21 indicates very low anxiety. That is usually a good thing. However, it is
possible that you might be unrealistic in either your assessment which would be denial or that you have
learned to mask the symptoms commonly associated with anxiety. Too little anxiety could indicate that
you are detached from yourself, others, or your environment.
A grand sum between 22 35 indicates moderate anxiety. Your body is trying to tell you something. Look
for patterns as to when and why you experience the symptoms described above. For example, if it occurs
prior to public speaking and your job requires a lot of presentations you may want to find ways to calm
yourself before speaking or let others do some of the presentations. You may have some conflict issues that
need to be resolved. Clearly, it is not panic time but you want to find ways to manage the stress you feel.
A grand sum that exceeds 36 is a potential cause for concern. Again, look for patterns or times when you
tend to feel the symptoms you have circled. Persistent and high anxiety is not a sign of personal weakness or
failure. It is, however, something that needs to be proactively treated or there could be significant impacts to
you mentally and physically. You may want to consult a physician or counselor if the feelings persist.

Dissociative Experiences Scale-II (DES-II)

Eve Bernstein Carlson, Ph.D. & Frank W. Putnam, M.D.

Directions: This questionnaire consists of twenty-eight questions about experiences that you may have in
your daily life. We are interested in how often you have these experiences. It is important, however, that
your answers show how often these experiences happen to you when you are not under the influence of
alcohol or drugs. To answer the questions, please determine to what degree the experience described in the
question applies to you, and circle the number to show what percentage of the time you have the
experience.
For example:
0% 10 20 30 40 50 60 70 80 90 100%
(Never)
(Always)
1. Some people have the experience of driving or riding in a car or bus or subway and suddenly realizing
that they dont remember what has happened during all or part of the trip. Circle a number to show what
percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
2. Some people find that sometimes they are listening to someone talk and they suddenly realize that they
did not hear part or all of what was said. Circle the number to show what percentage of the time this
happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
3. Some people have the experience of finding themselves in a place and have no idea how they got there.
Circle a number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
4. Some people have the experience of finding themselves dressed in clothes that they dont remember
putting on. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
5. Some people have the experience of finding new things among their belongings that they do not
remember buying. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
6. Some people sometimes find that they are approached by people that they do not know, who call them by
another name or insist that they have met them before. Circle the number to show what percentage of the
time this happens to you
0% 10 20 30 40 50 60 70 80 90 100%
7. Some people sometimes have the experience of feeling as though they are standing next to themselves
or watching themselves do something and they actually see themselves as if they were looking at another
person. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
8. Some people are told that they sometimes do not recognize friends of family members. Circle the number
to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
9. Some people find that they have no memory for some important events in their lives (for example, a
wedding or graduation). Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%

10. Some people have the experience of being accused of lying when they do not think that they have lied.
Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
11. Some people have the experience of looking in a mirror and not recognizing themselves. Circle the
number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
12. Some people have the experience of feeling that other people, objects, and the world around them are
not real. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
13. Some people have the experience of feeling that their body does not seem to belong to them. Circle the
number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
14. Some people have the experience of sometimes remembering a past event so vividly that they feel as if
they were reliving that event. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
15. Some people have the experience of not being sure whether things that they remember happening
really did happen or whether they just dreamed them. Circle the number to show what percentage of the
time this happens to you. 0% 10 20 30 40 50 60 70 80 90 100%
16. Some people have the experience of being in a familiar place but finding it strange and unfamiliar. Circle
the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
17. Some people find that when they are watching television or a movie they become so absorbed in the
story that they are unaware of other events happening around them. Circle the number to show what
percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
18. Some people find that they become so involved in a fantasy or daydream that it feels as though it were
really happening to them. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
19. Some people find that they sometimes are able to ignore pain. Circle the number to show what
percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
20. Some people find that they sometimes sit staring off into space, thinking of nothing, and are not aware of
the passage of time. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
21. Some people sometimes find that when they are alone they talk out loud to themselves. Circle the
number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%

22. Some people find that in one situation they may act so differently compared with another situation that
they feel almost as if they were two different people. Circle the number to show what percentage of the time
this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
23. Some people sometimes find that in certain situations they are able to do things with amazing ease and
spontaneity that would usually be difficult for them (for example, sports, work, social situations, etc.). Circle
the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
24. Some people sometimes find that they cannot remember whether they have done something or have
just thought about doing that thing (for example, not knowing whether they have just mailed a letter or have
just thought about mailing it). Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
25. Some people find evidence that they have done things that they do not remember doing. Circle the
number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%
26. Some people sometimes find writings, drawings, or notes among their belongings that they must have
done but cannot remember doing. Circle the number to show what percentage of the time this happens to
you.
0% 10 20 30 40 50 60 70 80 90 100%
27. Some people sometimes find that they hear voices inside their head that tell them to do things or
comment on things that they are doing. Circle the number to show what percentage of the time this happens
to you.
0% 10 20 30 40 50 60 70 80 90 100%
28. Some people sometimes feel as if they are looking at the world through a fog, so that people and objects
appear far away or unclear. Circle the number to show what percentage of the time this happens to you.
0% 10 20 30 40 50 60 70 80 90 100%

Dissociative Experiences Scale II (DES II)

Description and Interpretation
Description: The Dissociative Experiences Scale II (DES II) is a copyright-free, screening
instrument. According to its authors, Carlson and Putnam, it is a brief, self-report
measure of the frequency of dissociative experiences. The scale was developed to provide
a reliable, valid, and convenient way to quantify dissociative experiences. A response
scale that allows subject to quantify their experiences for each item was used so that
scores could reflect a wider range of dissociative symptomatology than possible using a
dichotomous (yes/no) format." (see Dissociation 6 (1): 16-23)!!
Interpretation: The Dissociative Experiences Scale II (DES II): When scoring, drop the
zero on the percentage e.g. 30%=3; 80%=8 then add up single digits for client score Mean
DES Scores Across Populations for Various Studies
General Adult Population
Anxiety Disorders
Affective Disorders
Eating Disorders
Late Adolescence
Schizophrenia
Borderline Personality Disorder
PTSD
Dissociative Disorder (NOS)
Dissociative Identity Disorder (MPD)

5.4
7.0
9.35
15.8
16.6
15.4
19.2
31
36
48

Items from the DES for Each of the Three Main Factors of Dissociation:
Amnesia Factor: This factor measures memory loss, i.e., not knowing how you got
somewhere, being dressed in clothes you dont remember putting on, finding new things among
belongings you dont remember buying, not recognizing friends or family members, finding evidence
of having done things you dont remember doing, finding writings, drawings or notes you must have
done but dont remember doing. Items 3, 4, 5, 8, 25, 26.
Depersonalization/Derealization Factor: Depersonalization is characterized by the recurrent
experience of feeling detached from ones self and mental processes or a sense of unreality of the
self. Items relating to this factor include feeling that you are standing next to yourself or watching
yourself do something and seeing yourself as if you were looking at another person, feeling your
body does not belong to you, and looking in a mirror and not recognizing yourself. Derealization is
the sense of a loss of reality of the immediate environment. These items include feeling that other
people, objects, and the world around them is not real, hearing voices inside your head that tell you
to do things or comment on things you are doing, and feeling like you are looking at the world
through a fog, so that people and objects appear far away or unclear.
Items 7, 11, 12, 13, 27, 28.
Absorption Factor: This factor includes being so preoccupied or absorbed by something that you
are distracted from what is going on around you. The absorption primarily has to do with ones
traumatic experiences. Items of this factor include realizing that you did not hear part or all of what
was said by another, remembering a past event so vividly that you feel as if you are reliving the
event, not being sure whether things that they remember happening really did happen or whether
they just dreamed them, when you are watching television or a movie you become so absorbed in
the story you are unaware of other events happening around you, becoming so involved in a fantasy
or daydream that it feels as though it were really happening to you, and sometimes sitting, staring
off into space, thinking of nothing, and being unaware of the passage of time.
Items 2, 14, 15, 17, 18, 20.