Perceived Stigmatization Questionnaire Form
Please indicate how much you agree or disagree with each statement below regarding your recent experiences. Your responses are anonymous and will help us better understand perceptions of stigmatization.
People have treated me differently because of my appearance.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I feel that others avoid interacting with me.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
People stare at me in public places.
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
I have been left out of social activities.
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
I feel self-conscious in social situations.
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
People have made negative comments about me.
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
I feel accepted by people around me.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I avoid certain situations because of how others might react.
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
How often do you feel judged by others?
*
Never
1
2
3
4
Very Often
5
1 is Never, 5 is Very Often
Overall, how much does perceived stigmatization affect your daily life?
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
Submit
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