Form No number No number Illness Perception Questionnaire

ILLNESS PERCEPTION QUESTIONNAIRE (IPQ-R)
Name………………………………

Date…………………………………

YOUR VIEWS ABOUT YOUR ILLNESS
Listed below are a number of symptoms that you may or may not have experienced since your
illness. Please indicate by circling Yes or No, whether you have experienced any of these symptoms
since your illness, and whether you believe that these symptoms are related to your illness.
I have experienced this
symptom since my illness

This symptom is related to
my illness

Pain

Yes

No

________________

Yes

No

Sore Throat

Yes

No

________________

Yes

No

Nausea

Yes

No

________________

Yes

No

Breathlessness

Yes

No

________________

Yes

No

Weight Loss

Yes

No

________________

Yes

No

Fatigue

Yes

No

________________

Yes

No

Stiff Joints

Yes

No

________________

Yes

No

Sore Eyes

Yes

No

________________

Yes

No

Wheeziness

Yes

No

________________

Yes

No

Headaches

Yes

No

________________

Yes

No

Upset Stomach

Yes

No

________________

Yes

No

Sleep Difficulties

Yes

No

________________

Yes

No

Dizziness

Yes

No

________________

Yes

No

Loss of Strength

Yes

No

________________

Yes

No

We are interested in your own personal views of how you now see your current illness.
Please indicate how much you agree or disagree with the following statements about your illness by
ticking the appropriate box.

VIEWS ABOUT YOUR ILLNESS
IP1

My illness will last a short time

IP2

My illness is likely to be permanent rather
than temporary
My illness will last for a long time

IP3
IP4

This illness will pass quickly

IP5

I expect to have this illness for the rest of my
life
My illness is a serious condition

IP6

STRONGLY
DISAGREE

DISAGREE

NEITHER
AGREE NOR
DISAGREE

AGREE

STRONGLY
AGREE

VIEWS ABOUT YOUR ILLNESS
IP7

My illness has major consequences on my life

IP8

My illness does not have much effect on my
life
My illness strongly affects the way others see
me
My illness has serious financial consequences

IP9

IP10
IP11

IP12

IP13

IP14

My illness causes difficulties for those who are
close to me
There is a lot which I can do to control my
symptoms
What I do can determine whether my illness
gets better or worse
The course of my illness depends on me

IP15

Nothing I do will affect my illness

IP16

I have the power to influence my illness

IP17

My actions will have no affect on the outcome
of my illness
My illness will improve in time

IP18
IP19

IP20

IP21

IP22

There is very little that can be done to
improve my illness
My treatment will be effective in curing my
illness
The negative effects of my illness can be
prevented (avoided) by my treatment
My treatment can control my illness

IP23

There is nothing which can help my condition

IP24

The symptoms of my condition are puzzling to
me
My illness is a mystery to me

IP25
IP26

I don’t understand my illness

IP27

My illness doesn’t make any sense to me

IP28

I have a clear picture or understanding of my
condition
The symptoms of my illness change a great
deal from day to day
My symptoms come and go in cycles

IP29

IP30
IP31

My illness is very unpredictable

IP32

I go through cycles in which my illness gets
better and worse.
I get depressed when I think about my illness

IP33
IP34

When I think about my illness I get upset

IP35

My illness makes me feel angry

IP36

My illness does not worry me

IP37

Having this illness makes me feel anxious

IP38

My illness makes me feel afraid

STRONGLY
DISAGREE

DISAGREE

NEITHER
AGREE NOR
DISAGREE

AGREE

STRONGLY
AGREE

CAUSES OF MY ILLNESS
We are interested in what you consider may have been the cause of your illness. As people are very
different, there is no correct answer for this question. We are most interested in your own views about the
factors that caused your illness rather than what others including doctors or family may have suggested to
you. Below is a list of possible causes for your illness. Please indicate how much you agree or disagree that
they were causes for you by ticking the appropriate box.

POSSIBLE CAUSES
C1

Stress or worry

C2

Hereditary - it runs in my family

C3

A Germ or virus

C4

Diet or eating habits

C5

Chance or bad luck

C6

Poor medical care in my past

C7

Pollution in the environment

C8

My own behaviour

C9

My mental attitude e.g. thinking about life
negatively
Family problems or worries caused my
illness
Overwork

C10

C11
C12

C13

STRONGLY
DISAGREE

DISAGREE

NEITHER
AGREE NOR
DISAGREE

AGREE

STRONGLY
AGREE

My emotional state e.g. feeling down, lonely,
anxious, empty
Ageing

C14

Alcohol

C15

Smoking

C16

Accident or injury

C17

My personality

C18

Altered immunity

In the table below, please list in rank-order the three most important factors that you now believe caused
YOUR illness. You may use any of the items from the box above, or you may have additional ideas of your
own.
The most important causes for me:1.

_______________________________________

2.

_______________________________________

3.

_______________________________________