BPQ-ANS Self Scoring Form — Traumatic Stress Research Consortium

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Assessment Tools

Assessment Tools Overview

Body Perception Questionnaire

Neuroception of Safety Scale

Brain Body Center Sensory Scales

Purpose in Life Scale

Assessment Tools

Assessment Tools Overview

Body Perception Questionnaire

Neuroception of Safety Scale

Brain Body Center Sensory Scales

Purpose in Life Scale

Folder: Assessment Tools

Assessment Tools Overview

Body Perception Questionnaire

Neuroception of Safety Scale

Brain Body Center Sensory Scales

Purpose in Life Scale

Body Perception Questionnaire ANS Symptoms (BPQ20-ANS)

The following questionnaire will ask you to respond to 20 statements. Please rate your awareness of each of the sensations listed described below.

Over the past week, how often have you been aware of the following sensations in your daily life?

1. I have difficulty coordinating breathing and eating.

Never Occasionally Sometimes Usually Always Not Applicable

2. When I am eating, I have difficulty talking.

Never Occasionally Sometimes Usually Always Not Applicable

3. My heart often beats irregularly.

Never Occasionally Sometimes Usually Always Not Applicable

4. When I eat, food feels dry and sticks to my mouth and throat.

Never Occasionally Sometimes Usually Always Not Applicable

5. I feel shortness of breath.

Never Occasionally Sometimes Usually Always Not Applicable

6. I have difficulty coordinating breathing with talking.

Never Occasionally Sometimes Usually Always Not Applicable

7. When I eat, I have difficulty coordinating swallowing, chewing, and/or sucking with breathing.

Never Occasionally Sometimes Usually Always Not Applicable

8. I have a persistent cough that interferes with my talking and eating.

Never Occasionally Sometimes Usually Always Not Applicable

9. I gag from the saliva in my mouth.

Never Occasionally Sometimes Usually Always Not Applicable

10. I have chest pains.

Never Occasionally Sometimes Usually Always Not Applicable

11. I gag when I eat.

Never Occasionally Sometimes Usually Always Not Applicable

12. When I talk, I often feel I should cough or swallow the saliva in my mouth.

Never Occasionally Sometimes Usually Always Not Applicable

13. When I breathe, I feel like I cannot get enough oxygen.

Never Occasionally Sometimes Usually Always Not Applicable

14. I have difficulty controlling my eyes.

Never Occasionally Sometimes Usually Always Not Applicable

15. I feel like vomiting.

Never Occasionally Sometimes Usually Always Not Applicable

16. I have 'sour' stomach.

Never Occasionally Sometimes Usually Always Not Applicable

17. I am constipated.

Never Occasionally Sometimes Usually Always Not Applicable

18. I have indigestion.

Never Occasionally Sometimes Usually Always Not Applicable

19. After eating I have digestive problems.

Never Occasionally Sometimes Usually Always Not Applicable

20. I have diarrhea.

Never Occasionally Sometimes Usually Always Not Applicable

The scores will display once you have responded to every statement.

You have completed the BPQ20-ANS. Your summary scores are below.

Total Score: 0
Your total score for body sensations that might be caused by activation of the autonomic nervous system. Some of these body sensations are common everyday experiences that may be caused by brief stress responses, medications, or medical conditions. However, particularly high scores may mean that your autonomic nervous system may be frequently activated by stress or chronic threat responses.

Percentile: %
Your score compared to a large, general population of adults in the United States (for example, a score of 70 means that you report more frequent autonomic symptoms than 70% of general population sample).

You can find further information about the interpretation of these values on the TSRC website by following this link

To protect confidentiality, this calculator does not save your data. If you wish to save your score, please copy and paste the text above to another location.

References

1. Kolacz, J., Chen, X., Nix, E. J., Roath, O. K., Holmes, L. G., Tokash, C., Porges, S. W., & Lewis, G. (2023). Association of self-reported autonomic symptoms with sensor-based physiological measures. Psychosomatic Medicine.

2. Kolacz, J., Chen, X., Nix, E. J., Roath, O. K., Holmes, L. G., Tokash, C., Porges, S. W., & Lewis, G. F. (2022). Measuring autonomic symptoms with the body perception questionnaire short form (BPQ-SF): Factor analysis, derivation of US adult normative values, and association with sensor-based physiological measures. medRxiv, 2022-04.

3. Cabrera, A., Kolacz, J., Pailhez, G., Bulbena-Cabre, A., Bulbena, A., & Porges, S. W. (2018). Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the Body Perception Questionnaire-Short Form (BPQ-SF). International journal of methods in psychiatric research, 27(2), e1596.

4. Porges, S. W. (1993). Body perception questionnaire. Laboratory of Developmental Assessment: University of Maryland.

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