Version June 2024
| Name: | Age: | Sex: Male / female (please circle as required) |
| Schooling: Primary / secondary / higher (eg, university) (please circle as required) | ||
| Please read instructions carefully: | ||
| This questionnaire describes strange and 'funny' experiences that normal people may have in their daily life. We are interested in their: (a) frequency, ie, how often you have had these experiences over the last six months and (b) their approximate duration. For each question, please circle the answers that suit you best. If you are not sure, give your best guess. | ||
| 1. Out of the blue, I feel strange, as if I were not real or as if I were cut off from the world. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 2. What I see looks 'flat' or 'lifeless', as if I were looking at a picture. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 3. Parts of my body feel as if they didn't belong to me. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 4. I have found myself not being frightened at all in situations which normally I would find frightening or distressing. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 5. My favourite activities are no longer enjoyable. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 6. Whilst doing something I have the feeling of being a "detached observer" of myself. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 7. The flavour of meals no longer gives me a feeling of pleasure or distaste. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 8. My body feels very light, as if it were floating on air. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 9. When I weep or laugh, I do not seem to feel any emotions at all. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 10. I have the feeling of not having any thoughts at all, so that when I speak it feels as if my words were being uttered by an 'automaton'. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 11. Familiar voices (including my own) sound remote and unreal. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 12. I have the feeling that my hands or my feet have become larger or smaller. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 13. My surroundings feel detached or unreal, as if there was a veil between me and the outside world. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 14. It seems as if things that I have recently done had taken place a long time ago. For example anything which I have done this morning feels as if it were done weeks ago. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 15. Whilst fully awake I have "visions" in which I can see myself outside, as if I were looking my image in a mirror. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 16. I feel detached from memories of things that have happened to me - as if I had not been involved in them. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 17. When in a new situation, it feels as if I have been through it before. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 18. Out of the blue, I find myself not feeling any affection towards my family and close friends. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 19. Objects around me seem to look smaller or further away. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 20. I cannot feel properly the objects that I touch with my hands for, it feels as if it were not me who were touching it. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 21. I do not seem able to picture things in my mind, for example, the face of a close friend or a familiar place. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 22. When a part of my body hurts, I feel so detached from the pain that if feels as if it were 'somebody else's pain.' | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 23. I have the feeling of being outside my body. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 24. When I move it doesn't feel as if I were in charge of the movements, so that I feel 'automatic' and mechanical as if I were a 'robot'. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 25. The smell of things no longer gives me a feeling of pleasure or dislike. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 26. I feel so detached from my thoughts that they seem to have a 'life' of their own. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 27. I have to touch myself to make sure that I have a body or a real existence. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 28. I seem to have lost some bodily sensations (eg, of hunger and thirst) so that when I eat or drink, it feels an automatic routine. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| 29. Previously familiar places look unfamiliar, as if I had never seen them before. | ||
| Frequency 0 = Never 1 = Rarely 2 = Often 3 = Very often 4 = All the time | Duration 1 = Few seconds 2 = Few minutes 3 = Few hours 4 = About a day 5 = More than a day 6 = More than a week | |
| Thank you for answering all the questions!! | ||
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