BSDS

Your birthdate and date of your first DBTCSD therapy session are needed for us to identify your data while keeping it anonymous to others. Your data will be transmitted securely as scrambled numbers without any text labels.
Birthday year (4 digits)
First Session was on
Name of therapist (primary therapist)
Filled out by



Please read through the entire passage below answering any questions.

Some individuals notice that their mood and/or energy levels shift drastically from time to time. These individuals notice that, at times, they are moody and/or their energy level is very low, and at other times, very high. During their "low" phases, these individuals often feel a lack of energy, a need to stay in bed or get extra sleep, and little or no motivation to do things they need to do. They often put on weight during these periods. During their low phases, these individuals often feel "blue," sad all the time, or depressed. Sometimes, during the low phases, they feel helpless or even suicidal. Their ability to function at work or socially is impaired. Typically, these low phases last for a few weeks, but sometimes they last only a few days. Individuals with this type of pattern may experience a period of "normal" mood in between mood swings, during which their mood and energy level feels "right" and their ability to function is not disturbed. They may then notice a marked shift or "switch" in the way they feel. Their energy increases above what is normal for them, and they often get many things done they would not ordinarily be able to do. Sometimes during those "high" periods, these individuals feel as if they have too much energy or feel "hyper". Some individuals during these high periods, may feel irritable, "on edge," or aggressive. Some individuals, during the high periods, may take on too many activities at once. During the high periods, some individuals may spend money in ways that cause them trouble. They may be more talkative, outgoing or sexual during these periods. Sometimes, their behavior during the high periods seems strange or annoying to others. Sometimes, these individuals get into difficulty with co-workers or police during these high periods. Sometimes, they increase their alcohol or nonprescription drug use during the high periods.


Now that you have read this passage, please check one of the following four options.
This story describes me very well, or almost perfectly
This story describes me fairly well
This story describes me to some degree, but not in most respects
This story does not really describe me at all

Now please put a check by each sentence that definitely describes YOU.

Some individuals notice that their mood and/or energy levels shift drastically from time to time.
These individuals notice that, at times, they are moody and/or their energy level is very low, and at other times, very high.
During their "low" phases, these individuals often feel a lack of energy, a need to stay in bed or get extra sleep, and little or no motivation to do things they need to do.
They often put on weight during these periods.
During their low phases, these individuals often feel "blue," sad all the time, or depressed.
Sometimes, during the low phases, they feel helpless or even suicidal.
Their ability to function at work or socially is impaired.
Typically, these low phases last for a few weeks, but sometimes they last only a few days.
Individuals with this type of pattern may experience a period of "normal" mood in between mood swings, during which their mood and energy level feels "right" and their ability to function is not disturbed.
They may then notice a marked shift or "switch" in the way they feel.
Their energy increases above what is normal for them, and they often get many things done they would not ordinarily be able to do.
Sometimes during those "high" periods, these individuals feel as if they have too much energy or feel "hyper".
Some individuals during these high periods, may feel irritable, "on edge," or aggressive.
Some individuals, during the high periods, may take on too many activities at once.
During the high periods, some individuals may spend money in ways that cause them trouble.
They may be more talkative, outgoing or sexual during these periods.
Sometimes, their behavior during the high periods seems strange or annoying to others.
Sometimes, these individuals get into difficulty with co-workers or police during these high periods.
Sometimes, they increase their alcohol or nonprescription drug use during the high periods.