Healing Questionnaire (Auto-Totals, Radio Buttons)

Self-Discovery Questionnaire: Uncovering Hidden Wounds and Limiting Beliefs

Before you begin.

Find a quiet, safe space where you won’t be interrupted
This is for your eyes only – be completely honest
If you feel overwhelmed at any point, take a break
Awareness is the first step toward healing
Consider having a trusted friend, counselor, or pastor available for support

Scoring Guide.

1 = Never true
2 = Rarely true
3 = Sometimes true
4 = Often true
5 = Always true

If you’ve experienced trauma, some questions may be triggering. Trust your instincts about what feels safe to explore right now.

PART A: PSYCHOLOGICAL PATTERNS (30 Questions)

Section 1: Self-Worth and Identity (5 Questions)

1. I feel like I have to earn love and acceptance through my performance or achievements.

Example: Working overtime constantly to prove your worth, feeling anxious when you’re not being “productive”

1. 2. 3. 4. 5.

2. I believe that if people really knew me, they would reject or abandon me.

Example:Hiding parts of your personality, not sharing struggles with friends, feeling like you’re “too

1. 2. 3. 4. 5.

3. I find it difficult to accept compliments or believe positive things about myself.

Example: Dismissing praise as “just being nice,” focusing on flaws when looking in mirror

1. 2. 3. 4. 5.

4. I feel responsible for other people’s emotions and try to fix their problems.

Example:Feeling guilty when others are upset, constantly trying to make everyone happy

1. 2. 3. 4. 5.

5. I struggle with imposter syndrome and fear being “found out” as inadequate.

Example: Attributing success to luck, fearing colleagues will discover you don’t belong

1. 2. 3. 4. 5.

Section 1 Total. /25

Section 2: Trust and Relationships (5 Questions)

6. I have difficulty trusting people and expect to be disappointed or betrayed.

Example:Assuming friends will cancel plans, not sharing personal information, testing people’s loyalty

1. 2. 3. 4. 5.

7. I either become overly dependent in relationships or remain completely independent.

Example: Losing yourself in romantic relationships, or never letting anyone get close

1. 2. 3. 4. 5.

8. I attract or stay in relationships where I’m taken for granted or mistreated.

Example: Friends who only call when they need something, partners who don’t respect boundaries.

1. 2. 3. 4. 5.

9. I have difficulty saying no and setting healthy boundaries.

Example: Agreeing to requests when overwhelmed, feeling guilty for having personal needs.

1. 2. 3. 4. 5.

10. I fear abandonment and will do almost anything to avoid being left alone.

Example: Staying in unhealthy relationships, compromising values to keep people happy.

1. 2. 3. 4. 5.

Section 2 Total. /25

Section 3: Control and Safety (5 Questions)

11. I need to control situations and people to feel safe and secure.

Example: Micromanaging family members, anxiety when plans change unexpectedly.

1. 2. 3. 4. 5.

12. I avoid taking risks or trying new things because I fear failure or judgment.

Example: Not applying for promotions, avoiding social events, staying in comfort zone.

1. 2. 3. 4. 5.

13. I have difficulty relaxing and always feel like I need to be “on guard.”

Example: Trouble sleeping, scanning for danger, difficulty enjoying peaceful moments

1. 2. 3. 4. 5.

14. I catastrophize situations and assume the worst possible outcome.

Example: Imagining disasters when someone is late, expecting rejection before job interviews

1. 2. 3. 4. 5.

15. I feel like I must be perfect to be acceptable to others.

Example: Spending hours on emails, fear of making mistakes, harsh self-criticism

1. 2. 3. 4. 5.

Section 3 Total. /25

Section 4: Emotions and Expression (5 Questions)

16. I suppress or deny my emotions because they feel dangerous or unacceptable.

Example: Never crying, immediately trying to “fix” sad feelings, fear of anger

1. 2. 3. 4. 5.

17. I feel overwhelmed by emotions and struggle to regulate them.

Example: Crying uncontrollably, explosive anger, feeling emotions very intensely

1. 2. 3. 4. 5.

18. I use substances, work, or other behaviors to numb painful feelings.

Example: Drinking when stressed, workaholism, compulsive shopping, endless scrolling

1. 2. 3. 4. 5.

19. I feel guilty or selfish when I prioritize my own needs and desires.

Example: Difficulty taking time for hobbies, feeling bad about spending money on yourself.

1. 2. 3. 4. 5.

20. I struggle with expressing anger in healthy ways.

Example: Explosive outbursts, passive-aggressive behavior, or complete suppression of anger

1. 2. 3. 4. 5.

Section 4 Total. /25

Section 5: Achievement and Success (5 Questions)

21. I believe I must achieve certain things to be worthy of love and respect.

Example: Feeling worthless without career success, measuring self-worth by bank account

1. 2. 3. 4. 5.

22. I procrastinate on important goals because I fear not meeting my own high standards.

Example: Delaying starting projects, not finishing creative work, paralysis from perfectionism

1. 2. 3. 4. 5.

23. I downplay my achievements and have difficulty celebrating successes.

Example: Minimizing accomplishments, immediately moving to next goal without acknowledgment

1. 2. 3. 4. 5.

24. I compare myself constantly to others and usually feel inferior.

Example: Social media comparison, feeling inadequate at social gatherings

1. 2. 3. 4. 5.

25. I abandon goals at the first sign of difficulty or setback.

Example: Quick to give up on diet plans, stopping courses when they get challenging

1. 2. 3. 4. 5.

Section 5 Total. /25

Section 6: Family and Cultural Patterns (5 Questions)

26. I carry heavy expectations about family loyalty that prevent me from setting boundaries.

Example: Unable to say no to family demands, guilt about living differently than family traditions

1. 2. 3. 4. 5.

27. I feel torn between my individual desires and what my family/community expects.

Example: Career choices based on family approval, hiding relationship choices, cultural shame

1. 2. 3. 4. 5.

28. I struggle with internalized messages about my racial, cultural, or economic identity.

Example: Feeling “not enough” or “too much” based on cultural background, economic shame

1. 2. 3. 4. 5.

29. I have difficulty expressing needs because “asking for help” was seen as weakness in my family.

Example: Suffering in silence, pride preventing vulnerability, “strong person” identity

1. 2. 3. 4. 5.

30. I repeat unhealthy patterns I witnessed in my family, despite wanting to be different.

Example: Communication styles, conflict patterns, parenting approaches, relationship dynamics

1. 2. 3. 4. 5.

Section 6 Total. /25

PART A TOTAL SCORE. /150

PART B: PHYSICAL PATTERNS (10 Questions)

Section 7: Experiences

31. I experience unexplained physical symptoms (headaches, stomach issues, tension) during stress.

Example: Migraines before family visits, digestive issues during conflict

1. 2. 3. 4. 5.

32. I have difficulty feeling safe and comfortable in my own body.

Example: Feeling disconnected from physical sensations, discomfort with touch

1. 2. 3. 4. 5.

33. I startle easily or feel hypervigilant in certain environments.

Example: Jumping at unexpected sounds, constantly scanning rooms for exits

1. 2. 3. 4. 5.

34. I hold tension in specific parts of my body (shoulders, jaw, stomach).

Example: Chronic neck pain, grinding teeth, tight chest when anxious

1. 2. 3. 4. 5.

35. I have sleep disturbances or nightmares related to past experiences.

Example: Difficulty falling asleep, recurring dreams, night sweats

1. 2. 3. 4. 5.

36. I struggle with eating patterns related to emotions or control.

Example: Stress eating, restricting food when upset, using food as comfort

1. 2. 3. 4. 5.

37. I feel disconnected from or uncomfortable with my sexuality/sensuality.

Example: Difficulty with intimacy, shame about body, disconnection from physical pleasure

1. 2. 3. 4. 5.

38. I have difficulty breathing deeply or feel short of breath during emotional moments.

Example: Shallow breathing when anxious, holding breath during conflict

1. 2. 3. 4. 5.

39. I experience fatigue that doesn’t match my physical activity level.

Example: Exhaustion from emotional situations, feeling drained after social interactions

1. 2. 3. 4. 5.

40. I notice my body “shutting down” or going numb during overwhelming situations.

Example: Feeling disconnected during conflict, emotional numbness, dissociation

1. 2. 3. 4. 5.

PART B TOTAL SCORE. /50

Total Score. /200

Self-Discovery Questionnaire: Uncovering Hidden Wounds and Limiting Beliefs

PART A: PSYCHOLOGICAL PATTERNS (30 Questions)

Section 1: Self-Worth and Identity (5 Questions)

Section 2: Trust and Relationships (5 Questions)

Section 3: Control and Safety (5 Questions)

Section 4: Emotions and Expression (5 Questions)

Section 5: Achievement and Success (5 Questions)

Section 6: Family and Cultural Patterns (5 Questions)

PART B: PHYSICAL PATTERNS (10 Questions)

Section 7: Experiences

Scoring and Interpretation

Immediate Self-Care & Next Steps

Based on Your Score.