SELF ESTEEM
1. I feel dirty, like there's something wrong with me. -- usually
2. Sometimes I think I'm crazy. -- sometimes
3. I feel ashamed. -- always
4. I'm different from other people. -- usually
5. I feel powerless. -- sometimes
6. If people really knew me, they'd leave. -- always
7. I want to die. -- rarely
8. I want to kill myself. -- never
9. I hate myself. -- usually
10. I have a hard time taking care of myself. -- sometimes
11. I don't deserve to be happy. -- sometimes
12. I don't trust my intuition or my feelings. -- rarely
13. I'm often confused. -- sometimes
14. I don't know how to set goals and follow through on them. -- sometimes
15. I'm scared of success. -- always
16. I'm a failure. I don't feel capable of doing a good job. -- sometimes
17. I use work to make up for empty feelings inside. -- sometimes
18. I'm a perfectionist. -- sometimes
19. I've made up a lot of stories about my life. rarely
20. I've done a lot of shoplifting. -- never
MY FEELINGS
1. I don't think feelings are very important. -- I don't think MINE are -- sometimes
2. I usually don't know what I'm feeling. -- rarely
3. I can't tell one feeling from another. -- rarely
4. I only experience one or two emotions. -- never
5. I have a hard time expressing my feelings. -- rarely
6. I have a hard time crying freely. -- sometimes
7. I cry all the time. -- sometimes
8. I get uncomfortable when I feel too happy. -- sometimes
9. I get nervous when things are relaxed and calm. -- rarely
10. I feel enraged a lot of the time. -- rarely
11. I'm rarely angry. Anger scares me. -- usually
12. I get depressed a lot. -- sometimes
13. I have a lot of nightmares. -- usually
14. I have panic attacks. -- sometimes
15. If I really let myself go, my feelings would be out of control. -- usually
16. I've been violent. -- never
17. I haven't been violent yet, but I'm worried I might be. -- never
MY BODY
1. I'm not "in my body" a lot of the time. -- sometimes
2. I frequently space out. -- sometimes
3. My body often feels numb. -- sometimes
4. I feel as if my body is separate from the rest of me. -- usually
5. I don't pay too much attention to my body's signals (hunger, tiredness, pain). -- usually
6. I think my body is ugly. -- always
7. I hide my body. -- always
8. I'm dyslexic. I had learning disabilities when I was growing up. -- sometimes
9. I use drugs or alcohol more than I think I should. -- rarely
10. I often eat compulsively. -- rarely
11. I keep myself from eating, or eat and throw up. -- usually
12. I hurt myself on purpose (cut, burn or injure myself) -- rarely
13. I have illnesses I think are related to my abuse. -- never
14. I've worked out to make my body strong so I wouldn't feel like a victim. -- usually
15. I've had flashbacks of the abuse during surgery or other medical procedures. -- usually
16. I'm scared to go to the dentist. I hate the feeling of things in my mouth. -- never
17. (For women) I'm scared to go to the gynecologist. -- always
INTIMACY
1. I often feel alienated from other people, as if I'm from another planet. -- sometimes
2. Most of my relationships just don't work. -- sometimes
3. I don't have many friends. -- always
4. I'm okay with my friends, but I just can't work things out with a lover. -- ?
5. I think I'm really meant to be alone. -- sometimes
6. I'm not sure I deserve to be loved. -- always
7. I don't know what love is. -- never
8. I find it hard to trust people. -- usually
9. I think people are going to leave me. -- all the fucking time!
10. I test people a lot. -- sometimes
11. It's hard for me to be nurtured or to nurture someone else. -- sometimes.
12. I'm clingy with people I'm close to. I'm afraid to be alone. -- usually
13. I'm scared of making commitment. When people get too close, I panic. -- sometimes
14. I have a hard time saying no. -- always
15. People take advantage of me in relationships. -- never
16. I get involved with people who are inappropriate or inaccessible. -- rarely
17. I've had relationships with people who remind me of my abuser. -- never
18. I'm struggling a lot with my partner. -- n/a
19. Sometimes I think my partner is my abuser. -- n/a
20. Sexual abuse is really creating problems in my relationship. -- n/a
SEXUALITY
1. I avoid sex. Deep down, I wish I never had to deal with sex again. -- usually
2. I am celibate. I haven't had sex in years. -- always
3. I really think sex is disgusting. -- rarely
4. I don't feel sexual desire. I think there's something basically wrong with it. -- sometimes
5. Sex isn't pleasurable for me. I usually have sex to make the other person happy. -- n/a
6. I try to use sex to meet most of my needs. -- never
7. It really feels like I'm "oversexed" -- never
8. Sex and aggression are really connected for me. -- ?
9. I find it hard to be close in nonsexual ways. It just isn't satisfying. -- never
10. I frequently go after sex I really don't want. -- never
11. Sex is the thing I'm best at. -- never
12. I've sold myself for sex. -- never
13. I've had sex with people who don't respect me. -- never
14. I need to control everything about sex. -- sometimes
15. I have a hard time staying present when I make love. I'm numb a lot during lovemaking. -- n/a
16. When I am sexual, I have terrifying, scary feelings I don't understand. -- usually
17. I often have flashbacks of my abuse while making love. -- n/a
18. I get sexually aroused when I read or talk about sexual abuse. -- never
19. Violent, sadistic fantasies turn me on. -- never
20. I'm ashamed of my sexuality. -- sometimes
21. I've sexually abused others. -- never
CHILDREN AND PARENTING
1. I feel awkward and uncomfortable around children. -- never
2. I have a hard time being affectionate with kids. -- never
3. I have a hard time setting boundaries with kids. -- never
4. I have a hard time balancing children's needs with my own. -- never
5. (For parents) I feel inadequate as a parent. -- n/a
6. I have trouble protecting children I take care of. -- never.
7. I tend to be overprotective. -- always
8. I've successfully protected children. -- always
9. I'm scared I'll be abusive. -- never
10. I have abused children. -- never
11. My kids have been abused (by someone else). -- n/a
MY FAMILY OF ORIGIN
1. I have strained relationships with my family. -- sometimes
2. Members of my family have rejected me (or vice versa) -- rarely
3. I have a hard time setting limits with my family. -- sometimes
4. People in my family invalidate my feelings and experiences. -- sometimes
5. I feel crazy when I'm around my family. -- sometimes
6. I can't be honest with the people in my family. -- sometimes
7. My abuse is still a secret in my family. -- always
8. I'm waiting for people in my family to come around and support me. never
If many of the statements on this list were familiar to you, you may feel overwhelmed right now. Put the purpose of this assessment is not to overwhelm you; it's to show you that there's a reason why you experience the things you do. It's to point out the areas that need healing. It is possible to dramatically alter your life so that your answers two years from now will bear little resemblance to your answers today.
1. When I look over my responses, I feel... -- sad
2. I've been most strongly affected in the areas of... -- self esteem, my body, my feelings, intimacy
3. I was least affected in the areas of... children, family
4. The hardest statements for me to acknowledge were... intimacy, sexuality
5. I feel the most hopeful about making changes in... my self esteem issues
6. I already made major strides in the following areas... my feelings
7. I feel the most hopeless about changing... intimacy, my body
8. I was surprised by...nothing really.
9. I learned... that I've come really far in the last year, but I want to go even further
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