Stress Test Evaluation for Adrenal Stress Index (ASI)

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Short History of Medicine:

2000 B.C.

Eat this root

1000 B.C.

Roots are heathen. Say a prayer.

1850 A.D.

Prayer is superstition. Take this potion.

1900 A.D.

That potion is snake oil. Take this pill.

1940 A.D.

That pill is useless. Take this antibiotic.

2000 A.D.

That antibiotic is no longer effective. Eat this root.

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Stress Test Evaluation for Adrenal Stress Index (ASI)

Part A:

To obtain the score, multiply points by duration in years.

Adrenal Related Problems	Points	x	Duration (Years)			Score
Excessive Dry Skin	10	x	½	1	2	_____
Dry & Thin Skin	10	x	½	1	2	_____
Nervous/Irritability	9	x	½	1	2	_____
Low Body Temperature	8	x	½	1	2	_____
Premenstrual Tension	8	x	½	1	2	_____
Inability to Concentrate	8	x	½	1	2	_____
Mental Depression	8	x	½	1	2	_____
Food Allergies & Sensitivities	7	x	½	1	2	_____
Craving for Sweets	7	x	½	1	2	_____
Headaches	6	x	½	1	2	_____
Alcohol Intolerance	6	x	½	1	2	_____
Poor Memory	5	x	½	1	2	_____
Heart Palipitations	5	x	½	1	2	_____

Total Score						_____________

30 or less: Minimal probability of Adrenal Axis-Stress related problem.

31 to 50: Moderate probability of Adrenal Axis-Stress related problem. ASI test worth consideration.

51 and above: High probability of Adrenal Axis-Stress related problem. ASI TEST RECOMMENDED.

Part B:
Do you have chronic pain: □ YES □ NO
Do you have chronic inflammation: □ YES □ NO

Part C:

Social Readjustment Rating Scale

Circle “Yes” or “No” regarding each life event that has happened in the last 12 months. For every “Yes” that applies, give yourself the points as listed. Upon completion, total the score and enter it on the line below.

Life Event	Answer		Points
Death of a spouse	Yes	No	100
Divorce	Yes	No	73
Marital separation	Yes	No	65
Jail Term	Yes	No	63
Death of close family member	Yes	No	63
Personal injury or illness	Yes	No	53
Marriage	Yes	No	50
Fired from work	Yes	No	47
Marital reconciliation	Yes	No	45
Retirement	Yes	No	45
Change in family members health	Yes	No	44
Pregnancy	Yes	No	40
Sex difficulties	Yes	No	39
Addition to family	Yes	No	39
Business readjustment	Yes	No	39
Change in financial state	Yes	No	38
Death of a close friend	Yes	No	37
Change to different line of work	Yes	No	36
Change in no. of arguments with spouse	Yes	No	35
Mortgage over $50,000	Yes	No	31
Foreclosure of mortgage	Yes	No	30
Change in responsibilities at work	Yes	No	29
Son or daughter leaving home	Yes	No	29
Trouble with in-laws	Yes	No	29
Outstanding Personal achievements	Yes	No	28
Spouse begins or stops work	Yes	No	26
Begin or end school	Yes	No	26
Change in living conditions	Yes	No	25
Revision of personal habits	Yes	No	24
Trouble with boss	Yes	No	23
Change in work hours or conditions	Yes	No	20
Change in residence	Yes	No	20
Change in school	Yes	No	20
Change in recreation	Yes	No	19
Change in religious activities	Yes	No	19
Change in social activities	Yes	No	18
Loan less than $50,000	Yes	No	17
Change in sleeping habits	Yes	No	16
Change in no. of family get-together	Yes	No	15
Change in eating habits	Yes	No	15
Change in eating habits	Yes	No	15
Vacation	Yes	No	13
Holidays	Yes	No	12
Minor violation of laws	Yes	No	11

Total Points: ________________________

Your susceptibility to illness and mental health problems:

Points:	Susceptibility:
up to 149	Low
150–200	Mild
200–299	Moderate
300 and up	Major