YSQ - $3 Jeffrey Young, Ph.D. Name Date Instructions Listed below are statements that people might use to describe themselves. Please read each statement, then rate itbased on how accurately it fits you over the past year. When you are not sure, base your answer on what you ‘emotionally feel, not on what you think to be true. A few of the items ask about your relationships with your parents or romantic partners. Ifany of these people have died, please answver these items based on your relationships when they were alive, If you do not currently havea partner but have had partners in the past, please answer the item based on your most recent significant romantic partner. Choose the highest rating from 1 to 6 that best describes you, and write the number in the white box to the left of, cach statement. Rating Scale |1 Completely untrue of me 3 Slightly more true than untrue 5 Mostly true of me 2 Mostly untrue of me 4 Moderately true of me 6 Describes me perfectly ' haven't had someone to nurture me, share him/herself with me, or care deeply about everything that happens to me, 2 find mysetf clinging to people I'm close to because I'm afraid they'll leave me I eel that People wil take advantage orm me. 4 I don' fit in, No man/woman | desire could love me once he or she saw my defects or flaws. 6 ‘Aimost nothing | do at work (or school) is as good as other people can do, | do not fee! capable of getting by on my own in everyday life. | can't seem to escape the feeling that something bad is about to happen. | have not been able to separate myself from my parent(s) the way other people my age seem to. 9 10 | think that if | do what | want, I'm only asking for trouble. n {im the one who usually ends up taking care of the people I'm close fo,4 Completely untue of me 3 Slightly more true than untrue Mostly true of me aa 3 | 2 2 Mostly untrue of mo. 4 Moderately rue of mo 6 Describes me perfectly | 1am too self-conscious to show positive feelings to others (e.g., affection, showing | I care). 3 | I must be the best at most of what | do; | can't accept second best. | Ihave a lot of trouble accepting “no” for an answer when | want something from Me | other people. 5 | | can't seem to discipline myself to complete most routine or boring tasks, 16 Having money and knowing important people make me feel worthwhile. y Even when things seem to be going well | feel that itis only temporary, 8 If | make a mistake, | deserve to be punished | are ie a 19 | don't have people to give me warmth, holding, and affection, 20 “I need other people s0 much that | worry about losing them. | eel that | cannot let my guard down in the presence of other people, or else they | will intentionally hurt me, 22. | ''m fundamentally different from other people. 23 | No one I desire would want to stay close to moifhe or she knew the real me. {'m incompetent when it comes to achievement. I think of myself as a dependent person when it comes to everyday functioning, ue | Heel that a disaster (natural, criminal, financial, or medical) could strike at any moment. 27 My parent(s) and | tend to be over-involved in each other's lives and problems. 5 | feel as if | have no choice but to give in to other people's wishes, or ese they will retaliate, get angry, or reject me in some way. 29 ~ | 1am a good person because | think of others more than mysell. | 30 I ind it embarrassing to express my feelings to others. 31 | | try to do my best | can't settle for “good enough.” || 1m special and shouldn't have to accept many of the restrictions or limitations oh placed on other people. 2 If cant each a goal, | become easily frustrated and give up, a4 Accomplishments are most valuable to me if other people notice them.1 Completely untrue of me 3 Slightly more tue than untue 8 Mostly tue of me ¥SQ-83 | 3 2 Mostly untrue of me 4 Moderately tue of me 6 Describes me perfectly T | If don't try my hardest, | should expect to lose out. | 'haven't felt that | am special to someone. | worry that people | fel close to will eave me or abandon me 39 Itis only a matter of ime before someone betrays me, 40 | !on't belong; 'm atoner. a I'm unworthy ofthe love, attention, and Fespect of others, 42 "| Most other people are more capable than lam in areas of work and ach 43 Hack common sense, a4 “worry about being physically attacked by people. itis very dificult for my parent(s) and me to Keep intimate details from each other o without feeling betrayed or guilty 46 In relationships, | usually let the other person have the upperhand. ae ti so busy doing things for the people that care about that | have little time for | myset. 48 I find it hard to be free-spirited and spontaneous around other people, “40 |_| Tmust mest all my responsiiltios, ee oe 50 I nate to be constrained or kept from doing what | want A Ihave a very difficult me sacrificing immediate gratification or pleasure to achieve a long-range goal. Unless | get alt of attention from others, fee less important. 53 | | You can't be too earefol something wil almost always go wrong, If don’t do the job right, | should suffer the consequences. ' have not had someone who really listens to me, understands me, or is tuned into o2 my true needs and feelings. When someone | care for seems to be pulling away or withdrawing from me, [feel | ne desperate. 7 |__| lamaute suspicious oroiner peoples moves | | | fee alenate or cutoff om other people heathy 59 I feel that I'm not lovable.1 Completely untrue of me 3 Slightly more true than untrue Mostly rue of me YSQ-S3 14 2 Mostly untrue of me 4 Moderatoly true of mo 6 Describes me perfectly 70. nm 76 7 2B 80 BL I'm not as talented as most people are at their work, My judgment cannot be counted on in everyday situations. | worry that lose all my money and become destitute or very poor. I often feel as if my parent(s) are living through me- that I don't have a life of my own. I've always let others make choices for me, so I really don’t know what I want for myself, Ive always been the one who listens to everyone else's problems. ! control myself so much that many people think | am unemotional or unfeeling. I feel that there is constant pressure for me to achieve and get things done. I eel that | shouldn't have to follow the normal rules or conventions that other people do, I can't force myself to do things | don't enjoy, even when | know it's for my own good. If make remarks at a meeting, or am introduced in a social situation, it's important for me to get recognition and admiration, No matter how hard I work, | worry that | could be wiped out financially and lose almost everything. Itdoesn't matter why I make a mistake. When | do something wrong, | should pay the consequences. [haven't had a strong or wise person to give me sound advice or direction when I'm not sure what to do. Sometimes | am so worried about people leaving me that | drive them away. |'m usually on the lookout for people's ulterior or hidden motives. | always feel on the outside of groups. | am too unacceptable in very basic ways to reveal myself lo other people or to let them get to know me well, 1'm not as intelligent as most people when it comes to work (or school). don't fee! confident about my ability to solve everyday problems that come up. | worry that 'm developing a serious illness, even though nothing serious has been diagnosed by a doctor. often feel | do not have a separate identity from my parent(s) or partner,1 Completely untrue of me 3 Slightly more true than unttue 5. Mostly tue of me YSQS3 | 5 2 Mostly unttue of me 4 Moderately true of me 6 Describes me perfectly | Ihave a lot of rouble demanding that my rights be respected and that my feelings #4 | be taken into account. 83 | Other people see me as doing too much for others and not enough for mysell. a4 | People see me as uptight emotionally. | | can't let myself off the hook easily or make excuses for my mistakes. ao | eet tnat wnat | have fo offeris of greater valve thn the contributions of thers. lie | Ihave rarely been able to stick to my resolutions. 88. Lots of praise and compliments make me feel like a worthwhile naan 89 I worry that a wrong decision could lead to disaster. cae 90 I'ma bad person who deserves to be punished y ee ©2014 Jefirey Young, Ph.D. Unauthorized reproduction or translation without written consent of the author is strictly prohibited. The small watermark is your assurance that you are using an authorized version ofthis inventory. Write: Schema ‘Therapy Institute, $61 1ath Ave, ‘Ste. 430, New York, NY 10036. E-mail: institute@schematherapy.com ‘Special thanks to Gary Brown, PhD, Scott Kellogg, Ph.D, Glenn Waller, Ph.D, and the many other therapists and researchers who have contibuted tothe development ofthe YSQ 3 edition.YSQ-S3 Scoring Form Jeffrey Young, Ph.D. Subject’s Name or ID Date Emotional Deprivation 1, 19. 37, 55. 73. Total. Mean Abandonment 2, 20. 38. 56. 74. Total, _ Mean Mistrust 3. 21. 39. 57. 75. Total. Mean Social Isolation / Alienation 4. 22. 40. 58. 76. Total. Mean Defectiveness / Unlovability 5. 23. 41. 59. 77. Total. Mean Failure to Achieve 6. 24, 42, 60. 78. Total, Mean Practical Incompetence/Dependence 7. 25. 43. 61. 79. Total. Mean, Vulnerability to Harm or Iliness 8. 26. 44. 62. 80. Total. Mean Enmeshment 9, 27. 45__ 63. 81, Total. Mean ‘The small watermark is your assurance that you are using an authorized version of this scoring formate¥8Q-83 Scoring | 2 Subjugation 10. 28. 46. 64. 82. Total. Mean Self-Sacrifice 14, 29, 47. 65, 83. Total_ Mean Emotional Inhibition 12, 30. 48. 66. _ 84. Total, Mean Unrelenting Standards 13, 31, 49. 67. 85. Total, Mean Entitlement/Superiority 14, 32. 50. 68. 86. Total, Mean = Insufficient Self-Control/Self-Discipline 15. 33. 51. 69. 87_ Total_____ Mean Adiration/Recognition-Seeking 16. 34. 52. 70. 88. Total Mean Pessimism/Worry 17. 35, 53. 71, 89. Total, Mean Self-Punitiveness: 18. 36, 54, 72. 90. Total, Mean se Total Score for YSQ-S3 Mean Score for YSQ-S3 ©2014 Jeffrey Young, Ph. Unauthorized reproduction or translation without written consent of the author is strictly prohibited Write: Schema ‘Therapy Institute, 561 1th Ave, Ste. 43D, New York, NY 10036 E-mail institute@schematheragyreamn