The Mind-Body Connection

Answer the questions below, using the symptom scale:

0=Never 1=Seldom 2=Occasionally 3=Frequently

4=Infrequently with severe symptoms 5=Almost always


Unable to forgive yourself

Have to please others excessively

Unable or unwilling to take a moral inventory of yourself

Relationships always difficult

Unable to express anger, sadness, or fear

Unable to have fun or do not allow yourself to have fun

Rarely touch or get touched by others

Unable to ask for what you need or want

Unable to believe in your own worth

Addictions to alcohol, drugs, sex, work, food, etc.


	Unable to confront or to say no

	Unable to relax / dont allow yourself to relax

		Feel you have little power or influence over your life

		Unable to forgive others

	Always acting in ways you do not like

Feel like a victim

		Low self-esteem, inferiority complex

		Feel need to be sneaky or to tell "white" or blatant lies

		Emotions govern behaviour to an excessive degree

Unresolved anger, bitterness, resentment (with parents, spouse, any close relationship, or with a situation)


Keep repeating negative or deleterious patterns or choices that end up harming you or others

Lonely, isolated, lacking meaningful / fulfilling connection to another person, family, group, organisation or pet


	Excessive exposure to industrial, agricultural, or garden and lawn chemicals, paints, fuels, solvents, etc.

Out of touch with your genuine needs, feelings, desires, talents, goals

Unusual and insurmountable fears that limit you significantly


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