IPDE ICD-10 module screening questionnaire Fist Name Directions ‘The purpose of this questionnaire isto learn what type of person you have been during the past five years. Please do not skip any items. If you are not sure of an answer, select the one- TRUE or FALSE-which is more likely to be correct. There is no time limit, but do not spend too much time thinking about the answer to any single statement. ‘When the answer is TRUE, circle the letter T. When the answer is FALSE, circle the letter F135 Screening questionnaire 1. usually get fun and enjoyment out of life. 2 {don’t react well when someone offends me. 3 Imnot fussy about litle details. 4 Ican'tdecide what kind of person want tobe. 5 show my feelings for everyone tose. 6 letothers make my big decisions forme. 71 usualy feel tense or nervous. 8 Lalmost never get angry about anything. 9 1 goto extremes to try to keep people from leaving me. 30 rma very cautious person. 11 Fvenever been arrested. 12 People think 'm cold and detached. 13 Igetinto very intense relationships that don’tlast. 14 Most people are fair and honest with me. 45 Ifind it hard to disagree with people if depend on them alot. 16 feel awkward or out of place in social situations. 17 Fimtoo easily influenced by what goes on around me. 18 I usualy feel bad when hurt or mistreat someone. 19 Largue or fight when people try to stop me from doing what | want. 20 Attimest'verafused to hold ajob, even when! was expected to, 21. When tm praised or criticized ! don't show others my reaction, 22 INeheld grudges against people for years. 23. spend too much time trying to do things perfectly. 24 People often make fun of me behind my back. 25 IWenever threatened suicide or injured myself on purpose. 26 My feelings are like the weather; they're always changing. 27 fight for my rights even when it annoys people. 28 Ike to dress so! stand out in a crowed. 29. willie or con someone if it serves my purpose 30. I don’t stick with aplan if don't get results right away. 31 Ihave litle or no desire tohave sex with anyone. 32 People think I'm too strict about rules and regulatiors. 33. | usually feel uncomfortable or helpless when I'm alone. 34 I won't get involved with people untli'm certain they like me. 35. |would rather not be the centre of attention. 136 | think my spouse (or lover) may be unfaithful to me. 37 Sometimes get so angry! break or smash things. 38 39 40 a a2 a 4 4s 46 ive had close friendships that lasted a long time. worry alot that people may not ike me, Loften feel “empty” inside. | work so hard {don't heve time left for anything ese. | worry about being eft alone and having to care for myself. Alot of things seem dangerous to me that don't bother most people. ‘have 2 reputation for being a fir. | don’t ask favors from people | depend on a ot. | prefer activities that ean do by myself AAA FAA itScreening questionnaire {ose my temper and get into physical fights People think '™m too stiff or formal. often seek advice or reassurance about everyday decisions. 1 eep to myself even when there are other people around. Wwshard for me to stay out of trouble. rm convinced there's a conspiracy behind many things in the world rmvery moody. shard for me to get used to a new way of doing things. ‘Most people think 'm a strange person. {ake chances and do reckless things. Everyone needs a friend or two to be happy. {tm more interested in my own thoughts than what goes on around me. usualy try to get people to da things my way.137 IPDE ICD-10 module screening questionnaire scoring summary LastName Name Middle Date 1 Circle the item numbers not followed byF, if they were answered True. Circle the remaining item numbers (those followed by F), if they were answered False 3 If three or more items from a disorder are circled, the subject has failed the screen for that disorder, and should be interviewed. Clinicians and investiga- tors may wish to adopt lower or higher screening standards, depending on the nature of the sample, and the relative importance to them of errors of sensitivity (false-negative cases) vs. specificity (false-positive cases) The screen should not be used to make a diagnosis or to caleulate a dimensional score for ‘a personality disorder. 760.0. Paranoid: 2 WF 2 mh OR 760.1. Schizoid: w 8 1 aS OST SB F60.2 Dissocial WF 18F 200 29 3F a7 60.30 Impulsive: 9 3% 37 5386 F60.31 Borderline: 4 9 13 Fr 40 F604 Histeioni 5 17 26 oF ot F605 Anankastic: ae 28 at aD F606 Anxious: 7 1% 34 39 43 50 60.7 Dependent: 6 1 33 a asa