This free survey is powered by QUESTIONPRO.COM
0%
 
 
My Emotional Health – What I believe-My Spirit
 
 
 
201. I believe that intuition is a powerful tool.
 
Yes
 
No
 
I’m not sure
 
 
 
202. I use my intuition to guide decisions about what is best for me and my health body.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
203. I believe in God, a higher power, spirit, or life force that directs, supports and comforts me.
 
Yes
 
No
 
I don’t know
 
 
 
204. I am honest with myself and others about my issues, in particular my needs and feelings.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
205. I feel that my wellness and weight loss goals are realistic and obtainable.
 
Yes
 
No
 
I don’t know
 
 
 
206. I have positive and reciprocal relationships with the people in my life.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
207. I have enough support from friends, family and/or a trained professional.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
208. My weight loss efforts are often sabotaged by other people.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
209. I avoid people I haven’t seen in a while because I am embarrassed by the way that I look.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
210. People’s negative comments affect the way that I feel about myself.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
211. I live in a safe environment, free from emotional, physical and/or verbal abuse.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
212. My weight affects the way I live and the decisions that I make.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
213. I am unhappy with what I see in the mirror.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
214. I feel like my eating is out of control.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
215. I think about food all the time.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
216. I am embarrassed by my weight.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
217. People don’t understand what I’m going through.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
218. I am often surprised by what I see in the mirror.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
219. I often feel isolated.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
220. I crave approval from others and lose sight of what I really want.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
221. I am intimidated by other people’s anger.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
222. I am more concerned with other's needs than my own.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
223. I crave excitement.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
224. I judge myself harshly.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
225. I feel that I am different from other people.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
226. I often take on the responsibilities of others and ignore my own needs.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
227. When things aren’t going well, it is easier to be by myself than with others.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
228. My home and/or office is full of old papers, clothing I don’t wear, and things I don’t use and no longer want.
 
Never
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
229. I am afraid that I’ll fail if I try another weight loss plan or diet.
 
Yes
 
No
 
I’m not sure
 
 
 
230. I have been in a serious relationship with someone I suspect or know is an alcoholic or has an addictive personality.
 
Yes
 
No
 
I’m not sure
 
 
 
231. Alcoholism and/or drug addiction runs in my family.
 
Yes
 
No
 
I don’t know
 
Please contact [email protected] if you have any questions regarding Section II of the Personal Factor Inventory.
Survey Software Powered by QuestionPro Survey Software