11AM - SURVEY

DP / Anxiety / Depression Survey

Basics
1. Gender
2. Age

Environment
3. Do you have a roomate or someone you live with? (Pets?)  Who?
4. Do you have a significant other?
5. Do you live in the city? suburbs? country?
6. What is the climate like where you live? (Do you have 4 seasons? 2? Does it rain more often than it is sunny?)
7. How clean is your living space on a scale of 1 - 10?

Heredity
8. Do you know if anyone else in your family has struggled with anxiety, depression or another disocciative disorder? Who?
9. At what age did your anxiety / DP / depression begin?

Personality Traits
10. Are you more the type to bottle up anger? or speak your mind immediately?
11. Do you prefer spending time alone or with a bunch of people?
12. On average, how many hours per week do you spend alone?
13. On average, how many hours per week do you spend socializing?
14. What causes you to become anxious? (Multiple answers, please.)

Traumatic Events
15. Have you recently experienced any traumatic events? (Car accident, death of a loved one...etc)
16. Have you ever experienced a traumatic event? -->Has anything lately happened that could have triggered memories from said traumatic event?

Medication
17. Do you currently take any medication related to your DP / Anxiety / Depression?
18. Have you ever taken medication for said reasons? When? For how long?

Health
19. Do you currently take vitamins or supplements? How long have you been taking them?
20. Do you exercise? How often?
21. What does your diet typically consist of?
22. Do you sleep every night? How many hours?

Grounding Yourself
23. What seems to make your condition better?
24. Over time, how has your condition seemed to progress?
25. What seems to make your condition worse?

If you feel I have left any important questions out, or want to add additional information, please let me know! It all helps!

Email me your numbered answers or message me on youtube.

ObservationsOfAnEarthCitizen@gmail.com