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What is the Beck Depression Inventory?

Beck depression checklist

The Beck Depression Inventory (BDI) is a 21-item depression checklist that was created by Aaron T. Beck, the man who created cognitive therapy. We utilize the Beck Depression Inventory as part of the intake process for the 14-Day Men’s Intensive at Begin Again Institute. This helps our staff establish safety protocols for each client as we move through treatment. 

History of the BDI

The BDI was designed in 1961 to assess the severity of depression in both normal and clinical populations. It can be used with people ages thirteen and older. Beck’s theory was that depression is caused by cognitive distortions, also called faulty thinking. 

Cognitive distortions are patterns of thinking or believing that are false or inaccurate and can cause psychological pain and damage. These errors in thinking can make symptoms of depression worse. Through cognitive-behavioral therapy (CBT) a therapist can help a person to change these faulty thoughts into healthy thinking patterns that can help alleviate and treat depressive symptoms. 

Many people have automatic negative thoughts. These thoughts can be challenged and replaced through CBT. Keeping a thought record of the automatic thoughts can help the person identify and understand their cognitive distortions.

There are a variety of different cognitive distortions. Some people engage in black or white thinking, where they believe there are only two possibilities and no shades of grey in between the two. Others apply qualifiers like “should”, “must”, and “always” to the statements they make about themselves and the world. There are many different distortions and a person who is depressed may partake in several different types.

To design the BDI, symptoms of people with depression were isolated from people without depression. Clients with depression would describe their experience to their therapist. The items used in the checklist are commonly found in people who are depressed, but are infrequent in those who are not depressed.

The BDI asks questions about mental symptoms as well as physical symptoms. A person who is depressed may describe their symptoms in a variety of ways:

  • Mood
  • Sense of failure
  • Guilt
  • Suicidal thoughts and feelings
  • Social withdrawal
  • Crying
  • Irritability
  • Fatigue
  • Insomnia
  • Increased or decreased appetite

a checklist for depression

Differences in the BDI and BDI-II

The BDI-II was developed in 1996 to reflect changes in the criteria used to diagnose depression in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Symptoms relating to weight loss, hypochondria, and working difficulty were removed, and the time frame for symptoms was changed to two weeks, the same time frame to diagnose major depressive disorder.

Is the BDI Reliable?

The BDI-II scores high on validity and reliability as a depression checklist. The changes made in the new version have ensured that the content being assessed is valid for persons with depression. It has shown to give consistent results when the same person is retested later. This is known as test-retest reliability. The BDI-II is sensitive to changes in depression across cultures.


The BDI scale rates common symptoms among people diagnosed with clinical depression. It can be given through an interview with the therapist or through self-report. The person with depression uses a 0-3 point Likert scale to rate how often they experience the symptoms.

The rating scale is as follows:

  • 0: I don’t feel sad
  • 1: I feel sad
  • 2: I’m sad all the time and can’t help it
  • 3: I am so sad I cannot stand it

The answers to each question are added together to score the depression checklist.

Here are the possible scores.

  • 0-10 none or minimal
  • 11-18 mild to moderate
  • 19-29 moderate to severe
  • 30-63 severe

This data is then used by the therapist to determine the best methods of treatment based on how severe the depression is. You can assess yourself with the BDI-II. 

Depression and Sex Addiction

Sex addiction, or hypersexuality, refers to people who have or think about sex more often than the average person. Sexual behavior is normal and healthy when it is consensual, causes no harm, and does not cause the person distress. 

Sometimes sex becomes an addiction. There is a strong link between depression and sex addiction. Hypersexual behavior can happen as a response to trauma such as sexual abuse especially during childhood, depression, anxiety, and other mental disorders or relationship issues.

Like with other types of addiction, it is common for a sex addiction to begin as a way to self-medicate for symptoms of depression. While some people who are depressed may turn to alcohol or drugs, some turn to sex as a way to make themselves feel better. This is because the same reward system in the brain that lights up with substance use is also active during sex and intimacy. 

During sex, the brain releases hormones and neurotransmitters that make you feel good. Dopamine is one of these key chemicals that floods the brain’s reward system during sex, substance use, and other pleasurable activities. The brain learns quickly that this feels much better than the state of depression it has been in, and the person repeats the behavior in order to feel better. 

Not everyone will become addicted, but some will. The key is to learn healthier ways of coping if sexual behavior is causing distress in the person’s life.

Depression with sex addiction is often mild but chronic, lasting for years. It may include some more intense major depressive episodes, and is frequently accompanied by low self-esteem and poor social skills.

The BDI-II can be an excellent checklist to assess depression in individuals experiencing symptoms of sex addiction. Once depression is diagnosed, treatment for depression may include trauma-informed treatment, CBT to change faulty thinking, rebuilding relationships, stress management, identifying triggers for sexual thoughts and behaviors, learning healthy alternative behaviors, and antidepressant medications as needed. 

At Begin Again Institute, we utilize the BECK Depression Inventory to help address the co-occuring conditions related to your sex addiction. If you are struggling with depression in addition to your sex addiction, the 14-Day Men’s Intensive can help. 

  • Category: Sex Addiction
  • By Ryan Pryor
  • December 2, 2020

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