Dr. Wilson’s Adrenal Fatigue Questionnaire
From Adrenal Fatigue: The 21st Century Stress Syndrome
by Dr. James L. Wilson
This questionnaire covers many of the common fatigue causes and stress symptoms associated with fatigued adrenals. Although not meant to be a stand-alone diagnostic tool, this stress quiz can be helpful in indicating the presence and degree of adrenal fatigue.
Instructions: Please enter the appropriate response number to each statement in the columns below. Use the values in the rating scale below. Once you have answered all of the questions, scroll to the bottom of the page and click the "Calculate" button. Your score and assessment will be tabulated and displayed.
Note: One column in the questionnaire is titled "Past" and another "Now." The past refers to the last time you felt well. If you cannot determine a specific date, then pick a relative time after which your symptoms seemed to noticeably worsen. It is helpful to write this date down so you do not forget it. All your responses in the "Past" column will be about how you felt before that date. The "Now" column is not necessarily about today, but about how you generally feel now, in this present time frame or since the date you entered for the "Past" column.
|0||Never / rarely|
|1||Occasionally / Slightly|
|2||Moderate in intensity or frequency|
|3||Intense / severe or frequent|
Interpreting your Adrenal Fatigue Questionnaire
Total Count of Questions Answered:
This gives you a general "Yes or No" answer to the question, "Do I have adrenal fatigue?" Look at your "Total number of questions answered" above. The purpose of this score is to see the total number of signs and symptoms of adrenal fatigue you have. There are a total of 87 questions for men and 89 questions for women in the questionnaire. If you responded to more than 26 (men) or 32 (women) of the questions, regardless of which severity response number you gave the question, you have some degree of adrenal fatigue. The greater the number of questions that you responded to, the greater your adrenal fatigue. If you responded affirmatively to less than 20 of the questions, it is unlikely that adrenal fatigue is your problem. People who do not have adrenal fatigue may still experience a few of these indicators in their lives, but not many of them. If your symptoms do not include fatigue or decreased ability to handle stress, the you are probably not suffering from adrenal fatigue.
The total points are used to determine the degree of severity of your adrenal fatigue. If you ranked every question 3 (the worst) your total points would be 261 for men and 267 for women. If you scored under 40, you either have only slight adrenal fatigue or none at all. If you scored between 44-87 for men or 45-88 for women, then overall you have a mild degree of adrenal fatigue. This does not mean that some individual symptoms are not severe, but overall your symptom picture reflects mildly fatigued adrenals. If you scored between 88-130 for men or 89-132 for women, your adrenal fatigue is moderate. If you scored above 130 for men or 132 for women, the consider yourself to be suffering from severe adrenal fatigue. Now compare the total points of the different sections with each other. This allows you to see if 1 or 2 of the sections stand out as having more signs and symptoms. They will be the most useful ones for you to watch as indicators as you improve. Seeing which sections stand out will also be helpful in developing your own recovery program.
The severity index is calculated by simply dividing the total points by the total number of questions you answered in the affirmative. It gives an indication of how severely you experience the signs and symptoms, with 1.0-1.6 being mild, 1.7-2.3 being moderate, and 2.4-3.0 being severe. This number is especially useful for those who suffer from only a few of these signs and symptoms, but yet are considerably debilitated by them.
Interpretation of the "Predisposing Factors" Section:
This section helps determine which factors led to the development of your adrenal fatigue. There may have been only one factor or there may have been several, but the number does not matter. One severely stressful incident can be all it takes for someone to develop adrenal fatigue, although typically it is more. This list is not exhaustive, but the items listed in this section are the most common factors that lead to adrenal fatigue. Use this section to better understand how your adrenal fatigue developed. Seeing how it started often makes clearer what actions you can take to successfully recover from it.
Key Factor Score:
This is the sum of the answers to the questions marked by an asterisk (*) for the "Now" column. If this total is more than 9, we strongly recommend that you consult a physician who is familiar with stress and adrenal function.
To learn more about what you can do:
- Go to Step #2 to read about adrenal fatigue, adrenal function and tests to establish adrenal efficiency.
- Go to Step #3 to learn about Dr Wilson’s programs and protocols, or use our search database to find a healthcare provider near you.
If you do not find a healthcare provider in your area, print this Patient Referral Form and take it to your current healthcare provider to see if he/she would like more information about adrenal fatigue and how to work with people experiencing this and other stress-related problems.