Items:

Borderline Personality Organization
1. I can make myself angry about something in the past just by thinking about it.
2. I get so angry, I feel that I might lose control.
3. If I let people see the way I feel, I’d be considered a hard person to get along with.
4. I see myself in totally different ways at different times.
5. I feel empty inside.
6. I tend to feel things in a somewhat extreme way, experiencing either great joy or intense despair.
7. It is hard for me to be sure about what others think of me, even people who have known me very well.
8. I feel people don’t give me the respect I deserve unless I put pressure on them.
9. Somehow, I never know quite how to conduct myself with people.

Trauma Symptom Checklist
10. I find it difficult to depend on other people.
11. I worry that I will be hurt if I allow myself to become too close to others.
12. I am somewhat uncomfortable being close to others.

Response Options:
If the statement is completely undescriptive of you – 1
If the statement is mostly undescriptive of you – 2
If the statement is partly undescriptive – 3
If the statement is mostly descriptive of you – 4
If the statement is completely descriptive of you – 5

Recollections of Early Childrearing
13. My parent pushed me even for small offenses.
14. As a child I was physically punished or scolded in the presence of others.
15. My parent gave me more corporal punishment than I deserved.
16. I felt my parent thought it was my fault when he/she was unhappy.
17. I think my parent was mean and grudging toward me.
18. I was punished by my parent with out of having done anything.
19. My parent criticized me and told me how lazy and useless I was in front of others.
20. My parent would punish me hard, even for trifles.
21. My parent treated me in such a way that I felt ashamed.
22. I was beaten by my parent.

Response Options:
Never occurred – 0
Occasionally occurred – 1
Often occurred – 2
Always occurred – 3

Trauma Symptom Checklist
How often have you experienced each of the following in the last two months? Please circle the appropriate number. 23. Insomnia.
24. Restless sleep.
25. Nightmares.
26. Anxiety attacks.
27. Fear of women.
28. Feeling tense all the time.
29. Having trouble breathing.

Response Options
Never - 0
Occasionally - 1
Fairly often – 2
Very often - 3