Instructions: The following statements describe how people sometimes feel. For each statement, please indicate how often you feel the way described by placing a check in the space provided. Here is an example: How often do you feel happy? If you never felt happy, you would check “never”; If you often feel happy, you would check “Often.” Check one option for each statement: Often — “I often feel this way” Sometimes — “I sometimes feel this way” Rarely — “I rarely feel this way” Never — “I never feel this way” How often do you feel unhappy doing so many things alone? Often Sometimes Rarely Never How often do you feel you have nobody to talk to? Often Sometimes Rarely Never How often do you feel you cannot tolerate being so alone? Often Sometimes Rarely Never How often do you feel as if nobody really understands you? Often Sometimes Rarely Never How often do you find yourself waiting for people to call or write? Often Sometimes Rarely Never How often do you feel completely alone? Often Sometimes Rarely Never How often do you feel you are unable to reach out and communicate with those around you? Often Sometimes Rarely Never How often do you feel starved for company? Often Sometimes Rarely Never How often do you feel it is difficult for you to make friends? Often Sometimes Rarely Never How often do you feel shut out and excluded by others? Often Sometimes Rarely Never Δ
