For each of the statements below, please consider your personal feelings. Determine how often, in general, the following experiences happen to you. Just give your gut response. Use the scale: 1 = Hardly ever to 7 = Almost always. Please read each statement carefully.
| Item | Hardly ever | ……………………………………… | Almost always | ||||
| 1. Others leave me out of their groups. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 2. Others keep me out-of-the-loop on information that is important to my close relationships. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 3. Others treat me as if I were invisible. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 4. Others give me the cold shoulder treatment. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 5. Others physically turn their backs to me when in my presence. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 6. Others treat me as if I’m in solitary confinement. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 7. Others do not look at me when I’m in their presence. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 8. Others ignore me during conversation. | 1 | 2 | 3 | 4 | 5 | 6 | 7 |