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Question of
Do you feel you sometimes forget things or have a hard time remembering?
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Yes
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No
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Question of
I have a perfect perception of my reality.
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Yes
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No
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Question of
Do you find yourself disconnected emotionally or physically from reality?
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Yes
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No
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Question of
I feel 100% comfortable with this person.
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Yes
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No
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Question of
This person has caused me trauma emotionally.
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Yes
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No
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Question of
I walk on eggshells with this person.
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Yes
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No
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Question of
I am more of a taker and not a giver.
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Yes
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No
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Question of
I sacrifice my emotions and well being to please this person.
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Yes
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No
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Question of
The world revolves around me and not the other person.
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Yes
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No
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Question of
I have gained or lost a lot of weight recently.
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Yes
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No
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Question of
I am having health issues related to emotionally trauma.
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Yes
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No
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Question of
I am healthy most of the time.
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Yes
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No
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Question of
I trust everyone I meet lately.
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Yes
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No
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Question of
I recently started not trusting what people say or do.
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Yes
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No
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Question of
I question peoples intentions.
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Yes
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No
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Question of
I love my life.
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Yes
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No
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Question of
I have thought about hurting myself.
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Yes
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No
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Question of
I feel isolated.
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Yes
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No
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Question of
I always go out and hang out with my friends and do whatever I want.
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Yes
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No
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Question of
I put blame on myself.
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Yes
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No
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Question of
I make excuses for people, especially those that hurt me.
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Yes
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No
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Question of
I have positive self talk.
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Yes
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No
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Question of
I know I am going to succeed in whatever I put my mind to.
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Yes
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No
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