By David Clarke MD and Howard Schubiner MD\
Introduction
This questionnaire is designed to improve understanding of your pain or other symptoms. The more questions to which you answer ‘Yes’ (the maximum is 37) the more likely it is that a mind-body condition (a Psychophysiologic Disorder or PPD) is contributing significantly to your symptom(s). Of course, these questions are only a screen for stresses capable of causing PPD.
They will not detect every stress that can cause pain or illness nor can they provide a definitive diagnosis. If you have concerns about your answer to any question, a discussion with a medical or mental health professional is recommended.
Symptom Questions
Certain symptom characteristics are more common in PPD than they are in organ disease or structural abnormalities.
1. Has your doctor completed diagnostic testing without finding a definite cause for your pain or other symptom(s)?
It is estimated that about 40% of people who see a primary care physician have PPD. If your answer to this question is yes, then the chance that you have PPD increases significantly from this 40% starting point. If your answer is no, you should complete your medical evaluation.
2. If your physician believes your symptoms are caused by an organ disease or structural abnormality, has your treatment not led to the expected improvement?
Most physicians are taught that an organ disease or structural abnormality located at the site of a patient’s symptom is almost certainly the cause of that symptom. However, this is not always the case. Many people (particularly as they age) develop abnormalities in their body (visible on x-rays, MRI or ultrasound) that cause no symptoms. This is particularly true when the abnormalities are in the spine, the larger joints, and the female pelvis. Therefore, to be thorough, we should routinely consider the possibility that PPD is the cause and not the visible abnormality. Suspicion that this is the case becomes greater when treatment aimed at the abnormality does not produce the expected benefit. Suspicion grows further the higher your score on this questionnaire.
3. Do you have more than one symptom?
The more symptoms you have, the more likely PPD is contributing to your condition. This is particularly true if you have six or more symptoms.
4. Are your symptoms located in different areas of the body?
The greater the number of locations of your symptoms and the more distant they are from each other, the more likely PPD is contributing to your condition.
5.Are these symptoms different in type?
If you have more than one symptom, the more they differ from each other (for example, headache and abdominal bloating) the more likely PPD is contributing.
6. Did the symptom begin with no obvious trigger or cause?
PPD symptoms commonly begin for little or no obvious reason, but some organ diseases and structural abnormalities also can do this.
7. If the symptom began after an injury, has it persisted long after the injury should have healed?
Healing of most physical injury is complete in 6 weeks or less. Symptoms that persist longer than 2-3 months after an injury commonly have a PPD contribution.
8. Does your symptom move or migrate to different body locations over time?
Symptoms caused by abnormal or diseased body organs and structures typically do not move from place to place. When symptoms shift their location, this is often an indication they are linked to PPD.
9. Do your symptoms have the quality of tingling, electric shock, burning, numbness, heat or cold?
These sensations are unusual in organ disease or structural abnormality and more common in PPD.
10. Are your symptoms more or less intense depending on the time of day, such as first thing in the morning or in the middle of the night?
Diseased organs or abnormal structures usually are not affected by time of day, the day of the week or your physical location (home, workplace etc) but PPD symptoms often are affected by these.
11. Do your symptoms occur after, but not during, activity or exercise?
Symptoms from a diseased organ or damaged structure will typically become worse when that area of the body is active and then improve with rest. In contrast, it is not unusual for PPD symptoms to become worse after rather than during activity.
12. Are your symptoms triggered by or increased by stress or thinking about stressful situations?
If this is true for you it suggests the brain is involved in causing your symptoms and this is usual for PPD.
13. Are your symptoms less severe or less frequent when you are engaged in enjoyable or distracting activities, such as vacation?
If this is true for you it suggests the brain is involved in causing your symptoms and this is usual for PPD. Diseased organs and abnormal structures typically are not affected by your external situation.
14. Are your symptoms less severe or less frequent when you are in an environment that feels safe for you?
If this is true for you it suggests the brain is involved in causing your symptoms and this is usual for PPD. In particular, people suffering from an Anxiety Disorder often answer ‘yes’ to this question. Diseased organs and abnormal structures typically are much less affected by your sense of personal safety.
15. Are your symptoms less severe or non-existent after physical treatment such as massage,chiropractic, Reiki, acupuncture, or after an herbal or vitamin supplement?
All forms of treatment have placebo benefits, and these are no exception. Clinical
experience suggests that these benefits are often greater in PPD than they are for organ disease or structural abnormalities,
16. Are your symptoms triggered by foods, smells, sounds, light, computer screens, menses, changes in the weather or specific movements?
Symptoms caused by organ disease or structural abnormality usually are not triggered by these, but PPD can be.
17. Are your symptoms triggered by the anticipation of stress, such as prior to school, work, a doctor’s visit, a medical test, a visit to a relative, a social gathering or during those activities?
Symptoms caused by organ disease or structural abnormality usually are not triggered by these, but PPD can be.
18. Are your symptoms triggered simply by imagining engaging in the triggering activity, such as bending over, turning the neck, sitting or standing?
Symptoms caused by organ disease or structural abnormality usually are triggered only by actual physical movement. However, in some people PPD can be triggered by
imagining that movement.
19. Are your symptoms triggered by light touch or gentle stimuli, such as the wind or cold?
Symptoms caused by organ disease or structural abnormality usually are not triggered by these, but PPD can be.
20. Earlier in your life, have you had other physical symptoms that your physician struggled to diagnose?
This is common for PPD patients but is much less common for people with symptoms
caused by organ disease or structural abnormalities.
Personality Trait Questions
Certain traits are common in people with PPD and can be a significant source of stress.
21. Would you describe yourself as highly detail-oriented or a perfectionist?
These personality traits are usually learned due to Adverse Childhood Experiences
(ACEs) which can be traumatic and obvious or subtle and difficult to recall. An
environment in which a child is taught that their best effort is not good enough can produce these traits. This long-term impact of ACEs is a stress that can significantly increase the risk for developing PPD. Fortunately, this issue can be successfully treated.
22. Is it highly important to you to please others or be seen as good by others?
This personality trait is usually learned due to Adverse Childhood Experiences (ACEs) which can be traumatic and obvious or subtle and difficult to recall. This long-term impact of ACEs is a stress that can significantly increase the risk for developing PPD. Fortunately, this issue can be successfully treated.
23. Are you often more critical of yourself than others are?
This personality trait is usually learned due to Adverse Childhood Experiences (ACEs) which can be traumatic and obvious or subtle and difficult to recall. This long-term impact of ACEs is a stress that can significantly increase the risk for developing PPD. Fortunately, this issue can be successfully treated.
24. Are people who caused stress for you as a child still active in your life?
This source of stress can contribute to PPD. It can be a significant challenge to set
boundaries to limit this stress. Fortunately, this issue can be successfully treated.
25. As an adult, have you been in close relationships with people outside your original family to whom you gave more of yourself than you received in return?
This personality trait is usually learned due to Adverse Childhood Experiences (ACEs) which can be traumatic and obvious or subtle and difficult to recall. This long-term impact of ACEs is a stress that can significantly increase the risk for developing PPD. Fortunately, this issue can be successfully treated.
26. As an adult, have you been in close relationships with people outside your original family who placed heavy demands on you, or tried to control, threaten or harm you?
This personality trait is usually learned due to Adverse Childhood Experiences (ACEs) which can be traumatic and obvious or subtle and difficult to recall. This long-term impact of ACEs is a stress that can significantly increase the risk for developing PPD. Fortunately, this issue can be successfully treated.
Mental Health and Stress Questions
These issues can be difficult to recognize at times.
27. Have you experienced a significant amount of stress in your life recently?
High levels of stress are common in people with PPD. It can help to make a list of every stress in your life. Keep the list with you and add to it as new ideas come up. Then, see if you can reduce the stress from some of the listed items.
28. Do you often neglect your own needs because you are taking care of others?
Usually this is learned due to Adverse Childhood Experiences (ACEs) which can be
traumatic and obvious or subtle and difficult to recall. The long-term impact of ACEs
significantly increases the risk for developing PPD. It can help to put yourself on the list of people for whom you care by regularly taking several hours each week for activity with no purpose but your own joy.
29. In the past or present, have you had an eating disorder (anorexia or bulimia), an addiction (drugs, alcohol, food, sex, work, gambling, shopping, exercise) or deliberately injured yourself such as by cutting?
These conditions are usually acquired in response to Adverse Childhood Experiences
(ACEs) which can be traumatic and obvious or subtle and difficult to recall. The long-
term impact of ACEs significantly increases the risk for developing PPD. Fortunately,
these issues can be successfully treated.
30. In the last two weeks, have you often felt nervous, anxious or on edge?
This can be an indication of an Anxiety Disorder, which is often a significant
contributing factor to PPD. The National Institute of Mental Health (NIMH) is a reliable source for additional information.
31. In the last two weeks, have you often felt unable to stop or control worrying?
This can be an indication of an Anxiety Disorder, which is often a significant
contributing factor to PPD. The National Institute of Mental Health (NIMH) is a reliable source for additional information.
32. In the last two weeks, have you often felt down, depressed or hopeless?
This can be an indication of Depression, a mental health condition that is often a
significant contributing factor to PPD. Other symptoms of depression include sleeping difficulty, fatigue, loss of appetite or thoughts about ending your life. (If so, let your physician know right away.) The National Institute of Mental Health (NIMH) is a reliable source for additional information.
In the last two weeks, have you often felt little interest or pleasure in doing things?
This can be an indication of Depression, a mental health condition that is often a
significant contributing factor to PPD. Other symptoms of depression include sleeping difficulty, fatigue, loss of appetite or thoughts about ending your life. (If so, let your physician know right away.) The National Institute of Mental Health (NIMH) is a reliable source for additional information.
34. Did your symptoms begin soon after a terrifying, traumatic or horrifying event or after a triggering event that is linked to a trauma?
Post-traumatic stress disorder (PTSD) is a common cause of PPD. Other symptoms of PTSD include flashbacks to or nightmares about the trauma, avoiding reminders of the trauma, being highly vigilant, and emotional numbness.
35. In the past month, have you often been bothered by repeated, disturbing memories, thoughts, images or dreams of a stressful experience?
This can be an indication of Post-Traumatic Stress Disorder. The National Institute of Mental Health (NIMH) is a reliable source for additional information.
36. In the past month, have you often been bothered by feeling very upset when something reminded you of a stressful experience?
This can be an indication of Post-Traumatic Stress Disorder. The National Institute of Mental Health (NIMH) is a reliable source for additional information.
37. If you learned that a child you care about was experiencing everything you did as a child, would you feel sad or angry?
If your answer is ‘yes’, this raises the possibility of your having current, ongoing effects of adverse childhood experiences (ACEs). You should also be aware that some people experienced ACEs that were subtle or difficult to recognize, leading them to answer this question ‘no’. All ACEs, subtle or not, can cause prolonged impact leading to PPD or to one or more of the following:
• Low self-esteem.
• Personality traits inquired about in questions 21 – 26 above
• Addictions (tobacco, alcohol, drugs, work, sex, eating, gambling, exercise, shopping).
• Eating disorders.
• Regularly finding yourself in relationships where you are treated disrespectfully.
• Cutting, burning or otherwise deliberately injuring yourself.
Concluding Thought
You can learn more about the stresses in this questionnaire at PPDAssociation.org/resources. Identifying sources of stress and successfully addressing them can lead to improvement and even relief of pain and other symptoms. When this occurs, it is excellent evidence that PPD is the correct diagnosis for your symptoms.