Mistrust Checklist

Rate your child on how often he or she behaves in the following ways.

0 - Never | 1 - Very Little | 2 - Moderately Often | 3 - Very Often

Behaviors

Numerous controlling behaviors
Never Very Little Moderately Very Often
Restlessness and hyperactivity (an absence of feeling safe)
Never Very Little Moderately Very Often
Inability to show affection (fearful of being vulnerable)
Never Very Little Moderately Very Often
Scapegoat mother or siblings with anger
Never Very Little Moderately Very Often
Difficulty praising others (fearful of allowing anyone to be close)
Never Very Little Moderately Very Often
Excessive social isolation
Never Very Little Moderately Very Often
Poor eye contact
Never Very Little Moderately Very Often
Few close friends
Never Very Little Moderately Very Often
Compulsive eating
Never Very Little Moderately Very Often
Excessive drinking or drug usage
Never Very Little Moderately Very Often
Addiction to pornography (escape to fantasy world)
Never Very Little Moderately Very Often
Tendency to isolate oneself
Never Very Little Moderately Very Often
Difficulty in receiving help or advice from others
Never Very Little Moderately Very Often
A need to have things his/her own way
Never Very Little Moderately Very Often
Not open to date
Never Very Little Moderately Very Often
Withdrawal from others in front of TV, books, computer, etc.
Never Very Little Moderately Very Often
Overly strong dealing with others (caused by fear of being hurt)
Never Very Little Moderately Very Often
Poor team player
Never Very Little Moderately Very Often
Compulsive masturbation
Never Very Little Moderately Very Often
Poor personal hygiene
Never Very Little Moderately Very Often
Aggressive behaviors
Never Very Little Moderately Very Often
Passive-aggressive behaviors
Never Very Little Moderately Very Often

Emotions

Regularly irritable or hostile (anger keeps others at distance)
Never Very Little Moderately Very Often
Overly anxious
Never Very Little Moderately Very Often
Over-reaction emotionally to minor life events
Never Very Little Moderately Very Often
Rarely relaxed or peaceful
Never Very Little Moderately Very Often
Bad temper
Never Very Little Moderately Very Often
Overly upset if things don't go as planned
Never Very Little Moderately Very Often
Very lonely (fearful of being vulnerable and of receiving love)
Never Very Little Moderately Very Often
Fearful of the future
Never Very Little Moderately Very Often
Emotional rigidity
Never Very Little Moderately Very Often
Lack of gentleness
Never Very Little Moderately Very Often
Panic attacks
Never Very Little Moderately Very Often

Thinking

Catastrophic thinking (something bad is going to happen)
Never Very Little Moderately Very Often
Rigid thinking - a lack of openness
Never Very Little Moderately Very Often
Excessive criticism of others (as a unconscious way to distance people)
Never Very Little Moderately Very Often
Negative thinking
Never Very Little Moderately Very Often
Suspiciousness
Never Very Little Moderately Very Often
Hypochondriacal thinking (fear of serious illness)
Never Very Little Moderately Very Often
Excessive fantasy life
Never Very Little Moderately Very Often
Obsessional fearful thoughts
Never Very Little Moderately Very Often
Paranoid thinking
Never Very Little Moderately Very Often
Obsessional thoughts of controlling others
Never Very Little Moderately Very Often

Physical Health

Irritable bowel syndrome
Never Very Little Moderately Very Often
Muscle spasms in different parts of the body
Never Very Little Moderately Very Often
Colitis
Never Very Little Moderately Very Often
Severe headaches
Never Very Little Moderately Very Often
Dizziness/lightheadedness
Never Very Little Moderately Very Often

Spiritual Life

Limited ability to receive love
Never Very Little Moderately Very Often
Anger with God
Never Very Little Moderately Very Often
Refuse to go to Church
Never Very Little Moderately Very Often
Limited ability to pray
Never Very Little Moderately Very Often
Withdrawal into religion (excess religiosity)
Never Very Little Moderately Very Often
Mistrust Total:
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