Name *

First Name

Last Name

I have difficulty identifying what I am feeling.

Always

Usually

Sometimes

Never

I minimize, alter, or deny how I truly feel.

Always

Usually

Sometimes

Never

I perceive myself as completely unselfish and dedicated to the well being of others.

Always

Usually

Sometimes

Never

I have difficulty making decisions.

Always

Usually

Sometimes

Never

I judge everything I think, say, or do, harshly, as never 'good enough'.

Always

Usually

Sometimes

Never

I am embarrassed to receive recognition and praise or gifts.

Always

Usually

Sometimes

Never

I do not ask others to meet my needs or desires.

Always

Usually

Sometimes

Never

I value others' approval of my thinking, feelings, or behavior over my own.

Always

Usually

Sometimes

Never

I do not perceive myself as a lovable or worthwhile person.

Always

Usually

Sometimes

Never

I compromize my own values and integrity to avoid rejection or others' anger.

Always

Usually

Sometimes

Never

I am very sensitive to how others are feeling and feel the same.

Always

Usually

Sometimes

Never

I am extremely loyal, remaining in harmful situations too long.

Always

Usually

Sometimes

Never

I value others' opinions and feelings more than my own and am afraid to express differing opinions and feelings of my own.

Always

Usually

Sometimes

Never

I put aside my own interests and hobbies in order to do what others want.

Always

Usually

Sometimes

Never

I accept sex when I want love.

Always

Usually

Sometimes

Never

I believe most other people are incapable of taking care of themselves.

Always

Usually

Sometimes

Never

I attempt to convince others of what they 'should' think and how they 'truly' feel.

Always

Usually

Sometimes

Never

I become resentful when others will not let me help them.

Always

Usually

Sometimes

Never

I freely offer others advice and directions without being asked.

Always

Usually

Sometimes

Never

I lavish gifts and favors on those I care about.

Always

Usually

Sometimes

Never

I use sex to gain approval and acceptance.

Always

Usually

Sometimes

Never

I have to be 'needed' in order to have a relationship with others.

Always

Usually

Sometimes

Never