Thorndon Dissociative Identity Disorder Explorer

If you experience any of the situations below, please circle the number that you feel indicates the frequency of the symptoms.

1 = Never

2 = occasionally

3 =a round once month

4= around once a week

5 = daily

1.  Sometimes I find things in my house that I don't recognize and don't know how they got there.

Frequency

______________________________________________

12345

2. I wake up in the morning and find things are not as I left them, things have moved or I'm wearing different clothes than when I went to bed.

Frequency

______________________________________________

12345

3. People say I drift off and seem vacant.

Frequency

______________________________________________

12345

4. I have a lot of difficulty keeping track of what I'm doing, e.g I loose where I'm up to in a book.

Frequency

______________________________________________

12345

5. I 'come to'  and realize I don't know where I am.

Frequency

______________________________________________

12345

Copyright The Thorndon Clinic 2009