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

I am physically and emotionally exhausted from morning until night

I am constantly thinking of my former love partner

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

I become upset when I think about my former love partner

I like being the person I am

I feel like crying because I feel so sad

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

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

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

I feel depressed

I feel emotionally separated from my former love partner

People would not like me if they got to know me

I feel comfortable seeing and talking to my former love partner

I feel like I am an attractive person

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

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

I feel lonely

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

I have many plans and goals for the future

I feel I don't have much sex appeal

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

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

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

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

Because my love relationship failed, I must be a failure

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

I feel comfortable being with people

I have trouble concentrating

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

I feel like an okay person

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

I have close friends who know and understand me

I am unable to control my emotions

I feel capable of building a deep and meaningful love relationship

I have trouble sleeping

I easily become angry at my former love partner

I am afraid to trust people who might become love partners

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

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

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

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

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

I feel very frightened inside

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

I feel uncomfortable even thinking about dating

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

I have noticed my body weight is changing a great deal

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

My abdomen feels empty and hollow

I have feelings of romantic love for my former love partner

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

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

I avoid people even though I want and need friends

I have really made a mess of my life

I sigh a lot

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

I perform my daily activities in a mechanical and unfeeling manner

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

I feel capable of facing and dealing with my problems

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

I am afraid of becoming sexually involved with another person

I feel adequate as a fe/male love partner

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

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

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

Life is somehow passing me by

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

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

I feel I know and understand myself

I feel emotionally committed to my former love partner

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

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

I am afraid of becoming emotionally close to another love partner

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

I can't believe our love relationship is ending

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

I have a normal amount of self-confidence

People seem to enjoy being with me

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

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

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

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

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

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

I feel guilty about my love relationship ending

I feel emotionally insecure

I feel uncomfortable even thinking about having a sexual relationship

I feel emotionally weak and helpless

I think about ending my life with suicide

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

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

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

I feel like I am going crazy

I am unable to perform sexually

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

I feel like a single person rather than a married person

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

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

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

What is your gender?

>Do you have kids?

> Where are you in the divorce process?

Did you initiate the divorce?

How long were you or have you been married?

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

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

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)

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