1. Whats your official diagnosis? Major Depressive Disorder….Anxiety Disorder

2. What do you think you have? Definately both those…probably ocd to..maybe some kind of personality disorder maybe

3. What medications are you currently on? Efexor – xr 225mg…valium

4. What medications have you been on before? Xanex, Seroquel, Lexepro, Prozac

5. Have you ever tired any natural remedies for depression? No..excercise i guess

6. Are you currently experiencing any side effects from your meds? Yea..a lil bit of fatigue, visual distubances and bad dreams

7. Have you ever been in a mental hospital? Mental health unit yes…2 weeks

8. If so, which ones? as above…just at prince charles hospital

9. Have you ever been in an outpatient program? Umm not sure what that is

10. Have you ever been to a day program? Like group kinda thing? i go to an anxiety group :/

11. Have you ever been to rehab? No

12. Have you ever been in a placement facility? No

13. Have you ever been in foster care? No

14 .How many therapists have you seen? 2

15. How many psychiatrists have you seen? 3

16. Did you ever tell any of your therapists or psychiatrists the truth? Yes always

17. Do you self injure at all? Yes 🙁

18. If so, how and what are your tools of choice? razor….or i'll take a lot of valium n drink, or i won't eat for days..

19. Do you hide your scars/marks? yes

20. How many people know you SI? a few close friends…some of my family

21. Have you ever gotten in trouble at school or work because of your scars/marks? No

22. How about because of your crazy behavior? Umm not really no

23. Have you ever thought about suicide? no

24. Did you ever write a suicide note? no

25. Did you ever gather the materials you needed for an attempt? no

26. Did you ever actually attempt suicide? no

27. Did you have to go the hospital because of your attempt? No

28. Ever had your stomach pumped or had to drink charcoal? No

29. Do you know anyone who actually committed suicide? yes…uncle

30. Do you hallucinate? not really…when im extra anxious i get the visual disturbances…or when im really tired and jus falling asleep my hearing goes a bit funny..thats also when im pretty stressed.

31. If so, what do you see? Nothing in particlular….jus like shadows for a couple of seconds

32. Do you hear things? Not really..my hearing goes funny though when in panic state

33. If so, what do you hear? …..

34. Do you have a creative outlet for your pain? umm not really..i write sometimes or listen to music

35. Do you have an outlet unrelated to your pain? i like poker n playing guitar n cruizn with friends..

36. Do you tend to gravitate towards mentally ill/unstable people as opposed to normal ones? probably bout even amount of each?

37. Are your romantic partners usually some variety of crazy? not totally..i can never seem to have stable rships though 🙁

38. Does mental illness run in your family? id say so

39. Were abused in any way as a child by a family member? no way

40. Were you abused in any way as a child by a school or religious official? no..

41. Were you abused in anyway as a child by anyone else? No

42. Have you ever been in an abusive relationship?emotional one yes

43. Do you tend to place blame on yourself or others/society/etc.? I blame myself a lot…but also ppl that are close to me to 🙁 i dont mean to

44. What 5 CDs do you listen to when your down? placebo…muse

45. When your having a low and are about to SI, are really depressed, etc., do you have any special rituals you normally do or things you like to have? dettol and my room with privacy

46. Are you addicted to anything? addictions come n go…so nothing in particular am i addicted to atm

47. If so, have any physical or mental problems been caused or made worse by your substance abuse? well drug n alcohol abuse hasnt bn good for my anxiety or paranoia

48. Do you cry from the pain? yes

49. Do you break things? not often

50. Do you verbally lash out at people?yes 🙁

51. Do you physically lash out at people? once or twice i have….but no way would i get like that now

52. Can you tell when your losing your grip on reality? heck yea…u'd think if i knew that i could stop it :/

53. Do you have any obsessive rituals? no open cupboards in my room when i sleep…sit on the same seat in the bus everytime i catch it…same seat in the car when im in it,

54. Do you get defensive when people try to help you with your illness? depends on what they are saying and how i am feeling at the time

55. Do you actually consider yourself crazy? maybe a lil wierd

56. Do you think your illness is a part of you, or something independent of you? Its definately a part of me

57. Have you ever had electric shock therapy? No, and I hope I never have to

58. Have you ever been tied down/restrained/given a PRN? handcuffed by the cops once..thats it though

59. Have you ever participated in any alternative forms of therapy? does tai chi count? umm music therapy

60. Do you actually want to get better? i want to be happy and have stable relationships and not be insecure and not push the people i care about most away all the time 🙁

Check all symptoms or traits that apply to you:
[x] Paranoia
[x] Anxiety
[x] Panic attacks
[x] Obsessive compulsive behavior
[ ] A learning disability
[x] Depersonalization
[ ] Homicidal feelings
[ ] Sociopathic tendancies
[ ] Autuism
[ ] Mania
[ ] Catatonic states
[ ] Delusions
[x] Violent outbursts
[ ] Stuttering
[ ] ADD
[x] Hyperacvity
[ ] Insomnia
[x] Night terrors
[ ] Nervous tics
[ ] Post traumatic stress
[x] Seperation anxiety
[ ] Dementia
[x] Any phobias
[ ] Anorexia
[ ] Bulimia
[ ] Another eating disorder
[ ] Pedophelia
[ ] Kleptomania
[ ] Pyromania
[ ] Gambling addiction
[ ] Anti-social
[x] Narsisstic
[x] Depression


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