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SAMPLE ITEMS FROM YSQ LONG FORM
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Listed below are statements that a person might use to describe himself or herself. Please read each statement and decide how well it describes you. When you are not sure, base your answer on what you emotionally feel, not on what you think to be true.
If you desire, reword the statement so that the statement would be even more true of you. Then choose the highest rating from 1 to 6 that describes you (including your revisions), and write the number in the space before the statement.
1 = Completely untrue of me
2 = Mostly untrue of me
3 = Slightly more true than untrue
4 = Moderately true of me
5 = Mostly true of me
6 = Describes me perfectly
I care about
A. 4 I worry that people ^ will not like me.
1._____ People have not been there to meet my emotional needs.
2._____ I haven't gotten love and attention.
3._____ For the most part, I haven't had someone to depend on for advice and emotional support.
4. _____ Most of the time, I haven't had someone to nurture me, share him/herself with me, or care deeply about everything that happens to me.
5._____ For much of my life, I haven't had someone who wanted to get close to me and spend a lot of time with me.
6. _____ In general, people have not been there to give me warmth, holding, and affection.
7. _____ For much of my life, I haven't felt that I am special to someone.
8. _____ For the most part, I have not had someone who really listens to me, understands me, or is tuned into my true needs and feelings.
9. _____ I have rarely had a strong person to give me sound advice or direction when I'm not sure what to do.
10._____I worry that the people I love will die soon, even though there is little medical reason to support my concern.
11. _____ I find myself clinging to people I'm close to because I'm afraid they'll leave me.
12. _____ I worry that people I feel close to will leave me or abandon me.
13.______I feel that I lack a stable base of emotional support.
14.______I don't feel that important relationships will last; I expect them to end.
15.______I feel addicted to partners who can't be there for me in a committed way.
16.______In the end, I will be alone.
17. _____ When I feel someone I care for pulling away from me, I get desperate.
18. _____ Sometimes I am so worried about people leaving me that I drive them away.
19.______I become upset when someone leaves me alone, even for a short period of time.
20.______I can't count on people who support me to be there on a regular basis.
21.______I can't let myself get really close to other people, because I can't be sure they'll always be there.
22.______It seems that the important people in my life are always coming and going.
23.______I worry a lot that the people I love will find someone else they prefer and leave me.
24.______The people close to me have been very unpredictable; one moment they're available and nice to me; the next, they're angry, upset, self-absorbed, fighting, etc.
25.______I need other people so much that I worry about losing them.
26.______I feel so defenseless if I don't have people to protect me that I worry a lot about losing them.
27.______I can't be myself or express what I really feel, or people will leave me.
28. _____ I feel that people will take advantage of me.
29. _____ I often feel that I have to protect myself from other people.
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