Cohen- Hoberman Inventory of Physical Symptoms
Cohen- Hoberman Inventory of Physical Symptoms (CHIPS)
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CHIPS
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Mark the number for each statement that best describes HOW MUCH THAT PROBLEM HAS BOTHERED OR DISTRESSED YOU DURING THAT PAST TWO WEEKS INCLUDING TODAY. Mark only one number for each item. At one extreme‚ 0 means that you have not been bothered by the problem. At the other extreme‚ 4 means that the problem has been an extreme bother.
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HOW MUCH WERE YOU BOTHERED BY:
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1. Sleep problems (can't fall asleep‚ wake up in middle of night or early in morning)
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0
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1
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2
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3
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4
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2. Weight change (gain or loss of 5 libs. or more)
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0
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1
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2
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3
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4
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3. Back pain
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0
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1
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2
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3
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4
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4. Constipation
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0
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1
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2
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3
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4
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5. Dizziness
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0
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1
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2
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3
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4
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6. Diarrhea
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0
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1
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2
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3
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4
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7. Faintness
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0
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1
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2
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3
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4
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8. Constant fatigue
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0
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1
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2
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3
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4
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9. Headache
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0
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1
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2
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3
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4
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10. Migraine headache
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0
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1
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2
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3
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4
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11. Nausea and/or vomiting
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0
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1
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2
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3
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4
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12. Acid stomach or indigestion
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0
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1
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2
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3
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4
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13. Stomach pain (e.g.‚ cramps)
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0
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1
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2
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3
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4
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14. Hot or cold spells
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0
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1
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2
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3
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4
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15. Hands trembling
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0
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1
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2
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3
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4
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16. Heart pounding or racing
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0
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1
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2
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3
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4
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17. Poor appetite
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0
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1
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2
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3
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4
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18. Shortness of breath when not exercising or working hard
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0
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1
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2
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3
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4
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19. Numbness or tingling in parts of your body
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0
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1
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2
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3
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4
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20. Felt weak all over
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0
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1
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2
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3
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4
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21. Pains in heart or chest
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0
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1
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2
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3
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4
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22. Feeling low in energy
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0
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1
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2
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3
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4
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23. Stuffy head or nose
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0
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1
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2
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3
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4
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24. Blurred vision
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0
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1
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2
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3
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4
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25. Muscle tension or soreness
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0
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1
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2
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3
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4
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26. Muscle cramps
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0
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1
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2
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3
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4
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27. Severe aches and pains
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0
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1
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2
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3
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4
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28. Acne
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0
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1
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2
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3
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4
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29. Bruises
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0
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1
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2
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3
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4
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30. Nosebleed
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0
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1
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2
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3
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4
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31. Pulled (strained) muscles
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0
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1
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2
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3
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4
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32. Pulled (strained) ligaments
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0
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1
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2
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3
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4
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33. Cold or cough
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0
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1
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2
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3
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4
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Cohen- Hoberman Inventory of Physical Symptoms (CHIPS)
To create a total score‚ sum the scores across the 33 items.
The CHIPS is a list if 33 common physical symptoms. Items were carefully selected so as to exclude symptoms of an obviously psychological nature (e.g.‚ felt nervous or epressed). The scale does‚ however‚ include many physical symptoms that have been traditionally viewed as psychosomatic (e.g.‚ headache‚ weight loss). Each item is rated for how much that problem bothered or distressed the individual during the past two weeks. Items are rated on a 5-point scale from "not at all" to "extremely".
