Stress Symptoms Input Form

Fill out the form below and hit the button to get your results.

Symptoms - Stage of Life

As we progress through life each stage is accompanied by its own unique stress sources. Indicate your stage by entering the number corresponding to the appropriate response.

Age
Under 18    18-25    25-45    45-65    over 65
Living arrangements
Alone    Family    Non-family group housing (dorm, apartment, etc.)
Sex
Male    Female
Occupation
Work in the home    Work outside the home    Unemployed
Student
College student    Not a college student

Distress Symptoms

Indicate the word that describes how often you experience each stress sign.
Perspiration: increased sweating or cold clammy hands.
Frequent need to urinate.
Voice changes; stuttering, shaky, strained, high pitch laughter.
Anxiety or panic: feeling things getting out of control.
Hyperactivity: sudden bursts of energy.
Poor diabetic control (if not diabetic mark never).
Difficulty falling asleep; insomnia; nightmares.
Fatigue, feeling tired.
Neuromuscular dysfunction; trembling, shaking, nervous tics, frowning, wrinkling forehead.
Impulsive behavior and/or accident proneness.
Daydreams; preoccupied, indecisiveness.
Skin changes; rashes, pimples, acne, temperature.
Re-occurring herpes.
Gastrointestinal symptoms: indigestion, gas pains, diarrhea, constipation, nausea, ulcers, rectal hemorrhoids.
Muscular tension: bruxism (grinding or clenching teeth), pain in jaw, neck, shoulders, back.
Low grade infections, flu.
Self-conscious: feelings of guilt, inadequacy, poor self-esteem.
Sexual dysfunction.
Migraine headaches.
Mental confusion, poor judgment, poor memory.
Women: menstrual difficulties(premenstrual tension/missed menstrual cycle, infertility. Men: infertility.
Cardiovascular symptoms: rapid heartbeat, chest pains, high blood pressure.
Tension headaches.
Kidney imbalance: bloating, water retention, excessive thirst.
Pessimistic attitude, conviction everything turns out for the worse.
Difficulty sitting still: pacing, finger or foot tapping.
Respiratory symptoms: shortness of breath, dizziness, hyperventilation.
Allergies, sores in mouth, hives.
Inability or difficulty concentrating, racing thoughts.
Arthritic joint pain.
Upper respiratory: colds, strep throat, mono.
Emotional tension and alertness: feeling frustrated, angry, restless, irritable, resentment.
Drymouth or throat; difficulty swallowing.
Emotional instability: feeling depressed, helpless, hopeless overpowering urge to cry and/or run and hide.
Loss or excessive appetite.
 

Signs of Distress

What are your signs of distress? See if you can identify which of these early warning signals precede your distress symptoms.

Feelings/Disposition
Confused, overwhelmed, swamped
Fear of inadequacy or failure
Irritable, impatient, angry outbursts
Worry
Uncomfortable, ill at ease, insecure
Feeling all wound up, nervous, tense
Feeling `blue', down in the dumps, weary

Behaviors
Engage in wasted motion and activity
Easily startled by small sounds
Increase in smoking and/or drinking alcohol
Increase or decrease in eating
Increase or decrease in sleeping
Forgetful
Withdrawal from usual activity

Body Reactions
Stomach upset, indigestion
Heart pounding
Muscles tense or `achy'
Rapid, shallow breathing
Nervous twitches, trembling
Excessive sweating
Rashes
Feeling of weakness or dizziness
Cold, clammy hands
Frowning, clenching jaw
Feeling worn out at the end of the day
Pouches or dark circles under eyes, eye strain