Dysregulation Quiz
This is a 15-question self-assessment about what may be dysregulating the body.
Name
First And Last Name
Email
example@example.com
Do You Feel Dysregulated?
*
Yes
No
Sometimes
INSTRUCTIONS
Select every option that honestly applies to you in each section.
Questions
Check ALL That Apply
When Something Stressful Happens…
My body tightens immediately (A)
I go quiet or withdraw (B)
I react quickly, then think later (C)
I feel it strongly in my body or lower abdomen (D)
I feel stuck or conflicted (E)
When I Try To Relax…
My mind won’t stop (A)
I feel numb or disconnected (B)
I get irritated easily (C)
My body feels uncomfortable or restless (D)
I feel guilty not being productive (E)
My Daily Energy Feels…
Wired but tired (A)
Low or drained (B)
Up and down quickly (C)
Dependent on my body or cycle (D)
Inconsistent (E)
When I’m Overwhelmed…
I push through anyway (A)
I shut down or check out (B)
I get emotional fast (C)
My body feels heavy or inflamed (D)
I freeze between options (E)
My Thoughts Are Usually…
Constant (A)
Foggy (B)
Reactive (C)
Emotional (D)
Conflicted (E)
When Making Decisions…
I overanalyze (A)
I avoid deciding (B)
I act fast, then reconsider (C)
My body/emotions influence me heavily (D)
I go back and forth (E)
When Something Triggers Me…
I replay it in my head (A)
I withdraw (B)
I respond immediately (C)
I feel it physically in my body (D)
I question myself (E)
My Sleep Tends To Be…
Restless (A)
Too much or never enough (B)
Interrupted by emotions/thoughts (C)
Affected by body discomfort (D)
Inconsistent (E)
When I Have Free Time…
I stay mentally active (A)
I scroll or zone out (B)
I get irritated easily (C)
I feel off but can’t explain it (D)
I overthink what to do (E)
My Relationship With My Body Feels…
Tense (A)
Distant (B)
Reactive (C)
Sensitive (D)
Confusing (E)
My Habits Tend To Be…
Over-controlled (A)
Avoidant (B)
Impulsive (C)
Influenced by how my body feels (D)
Inconsistent (E)
When I Attempt To Improve My Life…
I over-research (A)
I procrastinate (B)
I jump in too fast (C)
My body resists or feels off (D)
I start but don’t follow through (E)
My Emotions Feel…
Constant in the background (A)
Muted (B)
Intense and quick (C)
Physical in my body (D)
Contradictory (E)
When Interacting With Others…
I stay mentally alert (A)
I withdraw or disengage (B)
I react quickly (C)
I feel everything deeply in my body (D)
I second-guess myself (E)
Deep Down, My Biggest Struggle Feels Like…
I can’t turn off (A)
I can’t get started (B)
I can’t control my reactions (C)
My body feels out of sync (D)
I can’t stay consistent (E)
Get My Results
Should be Empty: