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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
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