Beck Depression Inventory - Welcome to My Practice

Date
MM slash DD slash YYYY
Name
First Last
1. Sadness*
- I do not feel sad.
- I feel sad.
- I am sad all the time and I can't snap out of it.
- I am so sad and unhappy that I can't stand it.
2. The Future*
- I am not particularly discouraged about the future.
- I feel discouraged about the future.
- I feel I have nothing to look forward to.
- I feel the future is hopeless and that things cannot improve.
3. Failure*
- I do not feel like a failure
- I feel I have failed more than the average person.
- As I look back on my life, all I can see is a lot of failures.
- I feel I am a complete failure as a person.
4. Satisfaction*
- I get as much satisfaction out of things as I used to.
- I don't enjoy things the way I used to.
- I don't get real satisfaction out of anything anymore.
- I am dissatisfied or bored with everything.
5. Guilt*
- I don't feel particularly guilty.
- Ifeel guilty a good part of the time.
- I feel quite guilty most of the time.
- I feel guilty all of the time.
6. Punished*
- I don't feel I am being punished.
- I feel I may be punished.
- I expect to be punished.
- I feel I am being punished.
7. Disappointment*
- I don't feel disappointed in myself.
- I am disappointed in myself.
- I am disgusted with myself.
- I hate myself.
8. Blame/Self Critical*
- I don't feel I am any worse than anybody else.
- I am critical of myself for my weaknesses or mistakes.
- I blame myself all the time for my faults.
- I blsme myself for everything bad that happens.
9. Suicidal thoughts*
- I don't have any thoughts of killing myself.
- I have thoughts of killing myself but I would not carry them out.
- I would like to kill myself.
- I would kill myself if I had the chance.
10. Tearfulness*
- I don't cry any more than usual.
- I cry more now than I used to.
- I cry all the time now.
- I used to be able to cry, but now I can't cry even though I want to.
11. Irritability*
- I am no mor irritated by things than I ever was.
- I am slightly more irritated now than usual.
- I am quite annoyed or irritated a good deal of the time.
- I feel irritated all of the time.
12. Interests*
- I have not lost interest in other people.
- I am less interested in other people than I used to be.
- I have lost most of my interest in other people.
- I have lost all of my interest in other people.
13. Decisiveness*
- I make decisions about as well as I ever could.
- I put off making decisions more than I used to.
- I have greater difficulty making decisions more than I used to.
- I can't make decisions at all anymore.
14. Looks*
- I don't feel I look any worse than I used to.
- I am worried that I am looking old or unattractive.
- I feel there are permanent changes in my appearance that make me look unattractive.
- I believe that I look ugly.
15. Effort*
- I can work about as well as before.
- It takes an extra effort to get started in doing something.
- I have to push myself very hard to do anything.
- I can't do any work at all.
16. Sleep*
- I can sleep as well as usual.
- I I don't sleep as well as I used to.
- I wake up 1 - 2 hours earlier than usual and find it hard to get back to sleep.
- I wake up several hours earlier than I used to and I can not get back to sleep.
17. Tiredness*
- I don't get more tired that usual.
- I get tired more easily than I used to.
- I get tired from doing almost anything.
- I am too tired to do anything.
18. Appetite*
- My appetite is no worse than usual.
- My appetite is not as good as it used to be.
- My appetite is much worse now.
- I have no appetite at all anymore.
19. Weight*
- I haven't lost much weight, if any, lately.
- I have lost more than five pounds.
- I have lost more than ten pounds.
- I have lost more than fifteen pounds.
20. Physical Health*
- I am no more worried about my health than usual.
- I am worried about physical problems like aches,pains, upset stomach or constipation.
- I am very worried about physical problems and it is hard to think of much else.
- I am so worried about my physical problems that I cannot think of anything else.
21. Sex*
- I have not noticed any recent changes in my interest in sex.
- I am less interested in sex than I used to be.
- I have almost no interest in sex.
- I have lost interest in sex completely.

Beck Depression Inventory (BDI)