I am comfortable telling people I am separated from my love partner
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am physically and emotionally exhausted from morning until night
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am constantly thinking of my former love partner
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel rejected by many of the friends I had when I was in the love relationship
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I become upset when I think about my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I like being the person I am
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel like crying because I feel so sad
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I can communicate with my Ex in a calm and rational manner
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
There are many things about my personaIity I would like to change
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
It is easy for me to accept my becoming a single person
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel depressed
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel emotionally separated from my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
People would not like me if they got to know me
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel comfortable seeing and talking to my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel like I am an attractive person
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel as though I am in a daze and the world doesn't seem real
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I find myself doing things just to please my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel lonely
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
There are many things about my body I would like to change
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have many plans and goals for the future
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel I don't have much sex appeal
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am relating and interacting in many new ways with people since my separation
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
Joining a singles group would make me feel I was a loser like them
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
It is easy for me to organize my daily routine of living
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I find myself making excuses to see and talk to my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
Because my love relationship failed, I must be a failure
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel like unloading my feelings of anger and hurt upon my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel comfortable being with people
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have trouble concentrating
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I think of my Ex as related to me rather than as a separate person
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel like an okay person
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I hope my Ex is feeling as much or more emotional pain than I am
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have close friends who know and understand me
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am unable to control my emotions
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel capable of building a deep and meaningful love relationship
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have trouble sleeping
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I easily become angry at my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am afraid to trust people who might become love partners
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
Because my love relationship ended, I feel there must be something wrong with me
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I either have no appetite or eat continuously which is unusual for me
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I don't want to accept the fact that our love relationship is ending
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I force myself to eat even though I'm not hungry
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have given up on my Ex and getting back together
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel very frightened inside
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
It is important that my family, friends, and associates be on my side rather than on my Ex's side
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel uncomfortable even thinking about dating
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel capable of living the kind of life I would like to live
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have noticed my body weight is changing a great deal
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I believe if we try, my love partner and I can save our love relationship
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
My abdomen feels empty and hollow
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have feelings of romantic love for my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I can make the decisions I need to because I know and trust my feelings
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I would like to get even with my Ex for hurting me
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I avoid people even though I want and need friends
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have really made a mess of my life
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I sigh a lot
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I believe it is best for all concerned to have our love relationship end
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I perform my daily activities in a mechanical and unfeeling manner
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I become upset when I think about my love partner having a love relationship with someone else
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel capable of facing and dealing with my problems
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I blame my Ex for the failure of our love relationship
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am afraid of becoming sexually involved with another person
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel adequate as a fe/male love partner
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
It will only be a matter of time until my love partner and I get back together
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel detached and removed from activities around me as though I were watching them on a movie screen
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I would like to continue having a sexual relationship with my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
Life is somehow passing me by
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel comfortable going by myself to a public place such as a movie
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
It is good to feel alive again after having felt numb and emotionally dead
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel I know and understand myself
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel emotionally committed to my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I want to be with people but I feel emotionally distant from them
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am the type of person I would like to have for a friend
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am afraid of becoming emotionally close to another love partner
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
Even on the days when I am feeling good, I may suddenly become sad and start crying
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I can't believe our love relationship is ending
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I become upset when I think about my love partner dating someone
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I have a normal amount of self-confidence
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
People seem to enjoy being with me
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
Morally and spiritually, I believe it is wrong for our love relationship to end
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I wake up in the morning feeling there is no good reason to get out of bed
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I find myself daydreaming about all the good times I had with my love partner
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
People want to have a love relationship with me because I feel like a lovable person
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I want to hurt my Ex by letting him/her know how much I hurt emotionally
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel comfortable going to social events even though I am single
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel guilty about my love relationship ending
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel emotionally insecure
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel uncomfortable even thinking about having a sexual relationship
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel emotionally weak and helpless
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I think about ending my life with suicide
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I understand the reasons why our love relationship did not work out
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel comfortable having my friends know our love relationship is ending
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am angry about the things my Ex has been doing
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel like I am going crazy
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I am unable to perform sexually
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel as though I am the only single person in a couples-only society
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel like a single person rather than a married person
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I feel my friends look at me as unstable now that I'm separated
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I daydream about being with and talking to my Ex
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
I need to improve my feelings of self-worth about being a wo/man
*
Almost Always
Usually
Sometimes
Seldom
Almost Never
What is your gender?
*
Female
Male
Prefer not to say
Do you have kids?
*
None
0-5 years old
6-12 years old
13-18 years old
19 or older
What do you do during normal work hours?
*
Stay at home parent
Physical/Active type of job
Managerial job
Desk Job
Not currently working/Other
Where are you in the divorce process?
*
Considering divorce
In the divorce process
Divorced
Did you initiate the divorce?
*
Yes
No
It was mutual
How long were you or have you been married?
*
0 to 5 years
6 to 10 years
11 to 15 years
16 to 20 years
21 years or more
How long ago did you get divorce or when do you expect to be divorced?
*
0 to 1 year ago
1 -2 years ago
2-5 years ago
6 or more years ago
In the next month
Sometime this year
Not sure
Please tell us a little bit about your story (optional)
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Did you/do you have many friends or family to talk to and support you during your divorce and soon after? (optional but very helpful)
Yes
No
Is there anything else you would like to share with us that might be helpful?
Zip Code/Postal code
*
First Name
Last Name
Email (so that we can send you your results)
*
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