1.
Separation from people close to me has made me worry what negative things (for example, accidents or injuries) might happen to them or to me
1 out of 10
2.
Separation has made me physically tense, interrupted my sleep patterns, or I have struggled to remain calm
2 out of 10
3.
Separation has caused me physical reactions, for example difficulty breathing, feeling faint, dizzy, or shaky
3 out of 10
4.
I have spent time and energy on planning for being separated
4 out of 10
5.
I have avoided places and situations where being separated is a possibility
5 out of 10
6.
I have left situations, events, or activities early in order to get home
6 out of 10
7.
In order to deal with separation, I have used alcohol or otherwise self-medicated, or relied on superstitious behaviors
7 out of 10
8.
Separation has made me feel horror, dread or great unease
8 out of 10
9.
I have tried to do and think things that will take my mind off being separated
9 out of 10
10.
Separation has made me feel jittery or apprehensive
10 out of 10
