Circle all that apply to you:

Physical

Mental

Spiritual

Appetite changes
Headaches
Fatigue
Poor sleeping
Increased alcohol
Frequent illnesses
Digestive problems
Pounding heart
Teeth grinding
Rash
Restlessness
Foot-tapping
Finger drumming
Nail Biting
Smoking
Forgetfulness
Poor concentration
Dull senses
Lethargy
Boredom
Low productivity
Negative attitude
Anxiety
The “blues”
Mood swings
Anger
Bad dreams
Irritability
Crying spells
Nervous laughter
Loss of loving feeling
Emptiness
Loss of meaning
Doubt
Martyrdom
Loss of direction
Cynicism
Apathy
Abandonment
Worry
Isolation
Distrust
“No one cares”

 

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