Welcome to the Divorce Self-Assessment.

This divorce self-assessment allows you to get a reliable score of the state of your mental health. As you move through your recovery process you will see your score rise.

The following statements are feelings and attitudes that people frequently experience after a love relationship has ended. Read each statement. Decide how frequently the statement applies to your present feelings and attitudes. Mark your response on your answer sheet. Do not leave any statements blank. If the statement is not appropriate for you in your present situation, answer the way you feel you might if that statement were appropriate.

After taking the self-assessment, your results will be immediately be sent to you. Please allow 15-20 minutes to take the self-assessment and should you need to leave the assessment, you may need to re-start again.

1.

I am comfortable telling people I am separated from my love partner

2.

I am physically and emotionally exhausted from morning until night

3.

I am constantly thinking of my former love partner

4.

I feel rejected by many of the friends I had when I was in the love relationship

5.

I become upset when I think about my former love partner

6.

I like being the person I am

7.

I feel like crying because I feel so sad

8.

I can communicate with my former love partner in a calm and rational manner

9.

There are many things about my personality I would like to change

10.

It is easy for me to accept my becoming a single person

11.

I feel depressed

12.

I feel emotionally separated from my former love partner

13.

People would not like me if they got to know me

14.

I feel comfortable seeing and talking to my former love partner

15.

I feel like I am an attractive person

16.

I feel as though I am in a daze and the world doesn't seem real

17.

I find myself doing things just to please my former love partner

18.

I feel lonely

19.

There are many things about my body I would like to change

20.

I have many plans and goals for the future

21.

I feel I don't have much sex appeal

22.

I am relating and interacting in many new ways with people since my separation

23.

Joining a singles group would make me feel I was a loser like them

24.

It is easy for me to organize my daily routine of living

25.

I find myself making excuses to see and talk to my former love partner

26.

Because my love relationship failed, I must be a failure

27.

I feel like unloading my feelings of anger and hurt upon my former love partner

28.

I feel comfortable being with people

29.

I have trouble concentrating

30.

I think of my former love partner as related to me rather than as a separate person

31.

I feel like an okay person

32.

I hope my former love partner is feeling as much or more emotional pain than I am

33.

I have close friends who know and understand me

34.

I am unable to control my emotions

35.

I feel capable of building a deep and meaningful love relationship

36.

I have trouble sleeping

37.

I easily become angry at my former love partner

38.

I am afraid to trust people who might become love partners

39.

Because my love relationship ended, I feel there must be something wrong with me

40.

I either have no appetite or eat continuously which is unusual for me

41.

I don't want to accept the fact that our love relationship is ending

42.

I force myself to eat even though I'm not hungry

43.

I have given up on my former love partner and getting back together

44.

I feel very frightened inside

45.

It is important that my family, friends, and associates be on my side rather than on my former love partner's side

46.

I feel uncomfortable even thinking about dating

47.

I feel capable of living the kind of life I would like to live

48.

I have noticed my body weight is changing a great deal

49.

I believe if we try, my love partner and I can save our love relationship

50.

My abdomen feels empty and hollow

51.

I have feelings of romantic love for my former love partner

52.

I can make the decisions I need to because I know and trust my feelings

53.

I would like to get even with my former love partner for hurting me

54.

I avoid people even though I want and need friends

55.

I have really made a mess of my life

56.

I sigh a lot

57.

I believe it is best for all concerned to have our love relationship end

58.

I perform my daily activities in a mechanical and unfeeling manner

59.

I become upset when I think about my love partner having a love relationship with someone else

60.

I feel capable of facing and dealing with my problems

61.

I blame my former love partner for the failure of our love relationship

62.

I am afraid of becoming sexually involved with another person

63.

I feel adequate as a fe/male love partner

64.

It will only be a matter of time until my love partner and I get back together

65.

I feel detached and removed from activities around me as though I were watching them on a movie screen

66.

I would like to continue having a sexual relationship with my former love partner

67.

Life is somehow passing me by

68.

I feel comfortable going by myself to a public place such as a movie

69.

It is good to feel alive again after having felt numb and emotionally dead

70.

I feel I know and understand myself

71.

I feel emotionally committed to my former love partner

72.

I want to be with people but I feel emotionally distant from them

73.

I am the type of person I would like to have for a friend

74.

I am afraid of becoming emotionally close to another love partner

75.

Even on the days when I am feeling good, I may suddenly become sad and start crying

76.

I can't believe our love relationship is ending

77.

I become upset when I think about my love partner dating someone

78.

I have a normal amount of self-confidence

79.

People seem to enjoy being with me

80.

Morally and spiritually, I believe it is wrong for our love relationship to end

81.

I wake up in the morning feeling there is no good reason to get out of bed

82.

I find myself daydreaming about all the good times I had with my love partner

83.

People want to have a love relationship with me because I feel like a lovable person

84.

I want to hurt my former love partner by letting him/her know how much I hurt emotionally

85.

I feel comfortable going to social events even though I am single

86.

I feel guilty about my love relationship ending

87.

I feel emotionally insecure

88.

I feel uncomfortable even thinking about having a sexual relationship

89.

I feel emotionally weak and helpless

90.

I think about ending my life with suicide

91.

I understand the reasons why our love relationship did not work out

92.

I feel comfortable having my friends know our love relationship is ending

93.

I am angry about the things my former love partner has been doing

94.

I feel like I am going crazy

95.

I am unable to perform sexually

96.

I feel as though I am the only single person in a couples-only society

97.

I feel like a single person rather than a married person

98.

I feel my friends look at me as unstable now that I'm separated

99.

I daydream about being with and talking to my former love partner

100.

I need to improve my feelings of self-worth about being a wo/man

101.

What is your gender?

102.

>Do you have kids?

103.

>What do you do during normal work hours?

104.

> Where are you in the divorce process?

105.

Did you initiate the divorce?

106.

How long were you or have you been married?

107.

How long ago did you get divorce or when do you expect to be divorced?

108.

Please tell us a little bit about your story (optional)

109.

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)

110.

Is there anything else you would like to share with us that might be helpful?




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