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Date of Birth

In what degree do the following potential symptoms appear? Please choose from 1 to 10. 1 being minimum and 10 being maximum

Self-hatred / Lack of self-esteem
Crying (frequency and intensity)
Irrational negative emotions
Panic attacks / Anxiety (frequency and intensity)
Lack of energy
Suicidal thoughts
Deep sadness
Sleep problems
Feelings of hopelessness
Moments of joy
Ability to control thoughts
Mood and laughter
Hope for the future
Ability to bring love and self-compassion to myself when I'm in a negative emotional state
Ability to observe and be present
General well-being
Healthy diet
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