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Nervous System Dysregulation Assessment: Are You Out of Balance?

 Instructions: Answer the questions on the following pages to assess whether your nervous system may be experiencing dysregulation. For each statement, indicate "Yes" if you experience what the question describes, or "No" if you do not.

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Physical Symptoms

This section explores how your body may be physically manifesting stress and nervous system dysregulation.

 

Question 2 of 30

I often feel tense or on edge without a clear reason.

A

Yes

B

No

Question 3 of 30

I frequently experience shallow or rapid breathing.

A

Yes

B

No

Question 4 of 30

I struggle with sleep issues, such as insomnia or waking up frequently.

A

Yes

B

No

Question 5 of 30

I experience frequent headaches, muscle tension, or chronic pain.

A

Yes

B

No

Question 6 of 30

I notice a racing heart or digestive problems when stressed.

A

Yes

B

No

Emotional Regulation

This section assesses your ability to manage and regulate emotions, a critical part of nervous system health.

Question 8 of 30

I often feel overwhelmed by daily tasks.

A

Yes

B

No

Question 9 of 30

I find it difficult to calm down after a stressful situation.

A

Yes

B

No

Question 10 of 30

I experience intense mood swings, feeling overly emotional or numb.

A

Yes

B

No

Question 11 of 30

I have a hard time identifying or expressing my emotions.

A

Yes

B

No

Question 12 of 30

I feel constantly anxious or agitated, even when there’s no obvious threat.

A

Yes

B

No

Cognitive and Mental Function

This section evaluates how nervous system dysregulation affects your mental clarity, focus, and cognitive processes. 

Question 14 of 30

I have trouble focusing or staying present in conversations or tasks.

A

Yes

B

No

Question 15 of 30

I feel scattered and jump from task to task without clear focus.

A

Yes

B

No

Question 16 of 30

I frequently experience “brain fog” and difficulty thinking clearly.

A

Yes

B

No

Question 17 of 30

I often feel like I’m on autopilot, disconnected from my surroundings.

A

Yes

B

No

Question 18 of 30

I find it hard to make decisions, even for simple tasks.

A

Yes

B

No

Stress and Reactivity

This section explores your ability to manage stress and how reactive you are to daily challenges.

Question 20 of 30

I find myself easily startled or hyper-alert in normal situations.

A

Yes

B

No

Question 21 of 30

I feel like I’m in “fight or flight” mode most of the time.

A

Yes

B

No

Question 22 of 30

I often shut down emotionally or feel numb when I’m stressed.

A

Yes

B

No

Question 23 of 30

I struggle to feel safe or relaxed, even in comfortable environments.

A

Yes

B

No

Question 24 of 30

I frequently overreact to small stressors or conflicts.

A

Yes

B

No

Behavioral Patterns

This section assesses behaviors that might indicate an attempt to cope with nervous system dysregulation.

Question 26 of 30

I engage in unhealthy coping mechanisms (e.g., overeating, substance use) to deal with stress.

A

Yes

B

No

Question 27 of 30

I have difficulty setting boundaries and often feel overwhelmed by others’ demands.

A

Yes

B

No

Question 28 of 30

I avoid certain situations or people because they trigger overwhelming emotions.

A

Yes

B

No

Question 29 of 30

I have trouble slowing down or resting, feeling the need to stay constantly busy.

A

Yes

B

No

Question 30 of 30

I feel stuck in unproductive patterns or habits and don’t know how to break free.

A

Yes

B

No

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