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IPDE

The document is a screening questionnaire designed to assess an individual's personality traits and behaviors over the past five years. It consists of a series of true or false statements that the respondent must answer without skipping any items. The questionnaire aims to gather insights into the person's emotional responses, social interactions, and overall mental state.

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tanukolpe
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7 views3 pages

IPDE

The document is a screening questionnaire designed to assess an individual's personality traits and behaviors over the past five years. It consists of a series of true or false statements that the respondent must answer without skipping any items. The questionnaire aims to gather insights into the person's emotional responses, social interactions, and overall mental state.

Uploaded by

tanukolpe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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134

IPDE ICD-10 module screening


questionnaire
Last Name First Name Middle . Date

Directions
T he purpose of this questionnaire is to learn what type of person you have

Deen dunng the past ftve yean.


Peesedo not skip any items. f you
TRUE Or FALSE-whkh s more
are not sure of an answer,
kely to be There is
select the one
correct. no time
limit
but do not spend too much time thinking about the answer to any single
statemer
is TRUE, drde the ieter T. When the
When
drde the answer
the leter E.
answer s FALSE,
155 Screening questionnaire

1lusuely get fun and enjoyment out of ife.


offends me.
2Idontreact well when someone
3Tm not fussy about litte detais.

a t dedde what kind of personI want to be.


shw my eeingsoeyone to see.
my big decisions for me.
elu5uelly
t othes meke
feel tense or nervOus
lalmost never get angy about anything.
to to try to keep people from lesing me.
go extremes
10 ma very cutious person
11 venever beenarrested.
12People think Fm cold end detached. don't las
into
13 get very intense relationships that
4Most peopie ere fair and honest wth me.
15 Ifind it herd to disagree with people ifi depend on them a lot
15 feel
Pm
or out of place in social situations.
avwkwardinfluenced
17
1
too easily by what goes on around me.
sully feel bad whenI hurtor mistreat someone.
19 argue or fight when people try to stop me from doing whatI want

021 When
At tdmesrve rerused to hold a job, ven whenI wes
expected
l'm preised or criticized Idont show others my reaction
to.

22 rveheld
grudges egeinst peopeo pertecty.
y i n g to do things
opeOten meke un ot me behnd my beck
n e e r threetened suidide or linjured myseff on purpose.
25My teelings are like the weedher, theyre awas dhenging.
27 Ifght for my rights even when t annoys people.
dres so l stand a orowd.
28ice to ou in
29 wi lie or con someone serves my purpose.
dontstiok with aplaen fI domt get resuls rigt away.
3o pveiethinkormo too
deire to have sex with enyone.
stritabou rules and reguedons.
3sualily feel uncomfortebie or helpless when P'm alone.
people rm oertaln they like me.
34won't get involved with until
w o u i d rether not be the centre ot ettention.
Ithink my spouse (or lover) may be unfalthful to me.
67 SometimesIget so angny I break or smash things
ehad that lasted a long time.
53 dose friendships
39
40
worry lota thet peoplemay not lke me.
loften feel "empty" Inside.
41 work so hardi dontt have time left for anything else.
worry about being let alone and having to care for mye.
A O t o things seem dangerous to me that dont bother most people.

ask
dont
46
tavons trom people
do
ldepend ona iot.
Ipreferactvitles thatican by myself.
146 of 237

136 Screening questionnaire

47 1ose my temper and get into physical fights.


48 People think "'m too stiff or formal.
49 1often seek advice or reassurance about everyday decisions.
even when other people around.
S0 Ikeepto myself there are
51 s hard for me to stay out of trouble.
52 Fm convinced
53 mvery moody.
there's a conspiracy behind many things in the world.

54 rshard for me to get used to a new way of doing things.


ss Most people think 'ma strange person.
S5 1take dhances
and do redtless things.
57 Everyone
S8
needsafrlend ortwo to be happy.
r'mmore interested in my own thoughts then what goes on around me.
59 Iusualy try to get people to do things my way

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