Student Adjustment Assessment 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 Almost Always Usually Sometimes Seldom Almost Never 2. I am physically and emotionally exhausted from morning until night Almost Always Usually Sometimes Seldom Almost Never 3. I am constantly thinking of my former love partner Almost Always Usually Sometimes Seldom Almost Never 4. I feel rejected by many of the friends I had when I was in the love relationship Almost Always Usually Sometimes Seldom Almost Never 5. I become upset when I think about my former love partner Almost Always Usually Sometimes Seldom Almost Never 6. I like being the person I am Almost Always Usually Sometimes Seldom Almost Never 7. I feel like crying because I feel so sad Almost Always Usually Sometimes Seldom Almost Never 8. I can communicate with my former love partner in a calm and rational manner Almost Always Usually Sometimes Seldom Almost Never 9. There are many things about my personality I would like to change Almost Always Usually Sometimes Seldom Almost Never 10. It is easy for me to accept my becoming a single person Almost Always Usually Sometimes Seldom Almost Never 11. I feel depressed Almost Always Usually Sometimes Seldom Almost Never 12. I feel emotionally separated from my former love partner Almost Always Usually Sometimes Seldom Almost Never 13. People would not like me if they got to know me Almost Always Usually Sometimes Seldom Almost Never 14. I feel comfortable seeing and talking to my former love partner Almost Always Usually Sometimes Seldom Almost Never 15. I feel like I am an attractive person Almost Always Usually Sometimes Seldom Almost Never 16. I feel as though I am in a daze and the world doesn't seem real Almost Always Usually Sometimes Seldom Almost Never 17. I find myself doing things just to please my former love partner Almost Always Usually Sometimes Seldom Almost Never 18. I feel lonely Almost Always Usually Sometimes Seldom Almost Never 19. There are many things about my body I would like to change Almost Always Usually Sometimes Seldom Almost Never 20. I have many plans and goals for the future Almost Always Usually Sometimes Seldom Almost Never 21. I feel I don't have much sex appeal Almost Always Usually Sometimes Seldom Almost Never 22. I am relating and interacting in many new ways with people since my separation Almost Always Usually Sometimes Seldom Almost Never 23. Joining a singles group would make me feel I was a loser like them Almost Always Usually Sometimes Seldom Almost Never 24. It is easy for me to organize my daily routine of living Almost Always Usually Sometimes Seldom Almost Never 25. I find myself making excuses to see and talk to my former love partner Almost Always Usually Sometimes Seldom Almost Never 26. Because my love relationship failed, I must be a failure Almost Always Usually Sometimes Seldom Almost Never 27. I feel like unloading my feelings of anger and hurt upon my former love partner Almost Always Usually Sometimes Seldom Almost Never 28. I feel comfortable being with people Almost Always Usually Sometimes Seldom Almost Never 29. I have trouble concentrating Almost Always Usually Sometimes Seldom Almost Never 30. I think of my former love partner as related to me rather than as a separate person Almost Always Usually Sometimes Seldom Almost Never 31. I feel like an okay person Almost Always Usually Sometimes Seldom Almost Never 32. I hope my former love partner is feeling as much or more emotional pain than I am Almost Always Usually Sometimes Seldom Almost Never 33. I have close friends who know and understand me Almost Always Usually Sometimes Seldom Almost Never 34. I am unable to control my emotions Almost Always Usually Sometimes Seldom Almost Never 35. I feel capable of building a deep and meaningful love relationship Almost Always Usually Sometimes Seldom Almost Never 36. I have trouble sleeping Almost Always Usually Sometimes Seldom Almost Never 37. I easily become angry at my former love partner Almost Always Usually Sometimes Seldom Almost Never 38. I am afraid to trust people who might become love partners Almost Always Usually Sometimes Seldom Almost Never 39. Because my love relationship ended, I feel there must be something wrong with me Almost Always Usually Sometimes Seldom Almost Never 40. I either have no appetite or eat continuously which is unusual for me Almost Always Usually Sometimes Seldom Almost Never 41. I don't want to accept the fact that our love relationship is ending Almost Always Usually Sometimes Seldom Almost Never 42. I force myself to eat even though I'm not hungry Almost Always Usually Sometimes Seldom Almost Never 43. I have given up on my former love partner and getting back together Almost Always Usually Sometimes Seldom Almost Never 44. I feel very frightened inside Almost Always Usually Sometimes Seldom Almost Never 45. It is important that my family, friends, and associates be on my side rather than on my former love partner's side Almost Always Usually Sometimes Seldom Almost Never 46. I feel uncomfortable even thinking about dating Almost Always Usually Sometimes Seldom Almost Never 47. I feel capable of living the kind of life I would like to live Almost Always Usually Sometimes Seldom Almost Never 48. I have noticed my body weight is changing a great deal Almost Always Usually Sometimes Seldom Almost Never 49. I believe if we try, my love partner and I can save our love relationship Almost Always Usually Sometimes Seldom Almost Never 50. My abdomen feels empty and hollow Almost Always Usually Sometimes Seldom Almost Never 51. I have feelings of romantic love for my former love partner Almost Always Usually Sometimes Seldom Almost Never 52. I can make the decisions I need to because I know and trust my feelings Almost Always Usually Sometimes Seldom Almost Never 53. I would like to get even with my former love partner for hurting me Almost Always Usually Sometimes Seldom Almost Never 54. I avoid people even though I want and need friends Almost Always Usually Sometimes Seldom Almost Never 55. I have really made a mess of my life Almost Always Usually Sometimes Seldom Almost Never 56. I sigh a lot Almost Always Usually Sometimes Seldom Almost Never 57. I believe it is best for all concerned to have our love relationship end Almost Always Usually Sometimes Seldom Almost Never 58. I perform my daily activities in a mechanical and unfeeling manner Almost Always Usually Sometimes Seldom Almost Never 59. I become upset when I think about my love partner having a love relationship with someone else Almost Always Usually Sometimes Seldom Almost Never 60. I feel capable of facing and dealing with my problems Almost Always Usually Sometimes Seldom Almost Never 61. I blame my former love partner for the failure of our love relationship Almost Always Usually Sometimes Seldom Almost Never 62. I am afraid of becoming sexually involved with another person Almost Always Usually Sometimes Seldom Almost Never 63. I feel adequate as a fe/male love partner Almost Always Usually Sometimes Seldom Almost Never 64. It will only be a matter of time until my love partner and I get back together Almost Always Usually Sometimes Seldom Almost Never 65. 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 66. I would like to continue having a sexual relationship with my former love partner Almost Always Usually Sometimes Seldom Almost Never 67. Life is somehow passing me by Almost Always Usually Sometimes Seldom Almost Never 68. I feel comfortable going by myself to a public place such as a movie Almost Always Usually Sometimes Seldom Almost Never 69. It is good to feel alive again after having felt numb and emotionally dead Almost Always Usually Sometimes Seldom Almost Never 70. I feel I know and understand myself Almost Always Usually Sometimes Seldom Almost Never 71. I feel emotionally committed to my former love partner Almost Always Usually Sometimes Seldom Almost Never 72. I want to be with people but I feel emotionally distant from them Almost Always Usually Sometimes Seldom Almost Never 73. I am the type of person I would like to have for a friend Almost Always Usually Sometimes Seldom Almost Never 74. I am afraid of becoming emotionally close to another love partner Almost Always Usually Sometimes Seldom Almost Never 75. Even on the days when I am feeling good, I may suddenly become sad and start crying Almost Always Usually Sometimes Seldom Almost Never 76. I can't believe our love relationship is ending Almost Always Usually Sometimes Seldom Almost Never 77. I become upset when I think about my love partner dating someone Almost Always Usually Sometimes Seldom Almost Never 78. I have a normal amount of self-confidence Almost Always Usually Sometimes Seldom Almost Never 79. People seem to enjoy being with me Almost Always Usually Sometimes Seldom Almost Never 80. Morally and spiritually, I believe it is wrong for our love relationship to end Almost Always Usually Sometimes Seldom Almost Never 81. I wake up in the morning feeling there is no good reason to get out of bed Almost Always Usually Sometimes Seldom Almost Never 82. I find myself daydreaming about all the good times I had with my love partner Almost Always Usually Sometimes Seldom Almost Never 83. People want to have a love relationship with me because I feel like a lovable person Almost Always Usually Sometimes Seldom Almost Never 84. I want to hurt my former love partner by letting him/her know how much I hurt emotionally Almost Always Usually Sometimes Seldom Almost Never 85. I feel comfortable going to social events even though I am single Almost Always Usually Sometimes Seldom Almost Never 86. I feel guilty about my love relationship ending Almost Always Usually Sometimes Seldom Almost Never 87. I feel emotionally insecure Almost Always Usually Sometimes Seldom Almost Never 88. I feel uncomfortable even thinking about having a sexual relationship Almost Always Usually Sometimes Seldom Almost Never 89. I feel emotionally weak and helpless Almost Always Usually Sometimes Seldom Almost Never 90. I think about ending my life with suicide Almost Always Usually Sometimes Seldom Almost Never 91. I understand the reasons why our love relationship did not work out Almost Always Usually Sometimes Seldom Almost Never 92. I feel comfortable having my friends know our love relationship is ending Almost Always Usually Sometimes Seldom Almost Never 93. I am angry about the things my former love partner has been doing Almost Always Usually Sometimes Seldom Almost Never 94. I feel like I am going crazy Almost Always Usually Sometimes Seldom Almost Never 95. I am unable to perform sexually Almost Always Usually Sometimes Seldom Almost Never 96. I feel as though I am the only single person in a couples-only society Almost Always Usually Sometimes Seldom Almost Never 97. I feel like a single person rather than a married person Almost Always Usually Sometimes Seldom Almost Never 98. I feel my friends look at me as unstable now that I'm separated Almost Always Usually Sometimes Seldom Almost Never 99. I daydream about being with and talking to my former love partner Almost Always Usually Sometimes Seldom Almost Never 100. I need to improve my feelings of self-worth about being a wo/man Almost Always Usually Sometimes Seldom Almost Never 101. What is your gender? Female Male Prefer not to say 102. >Do you have kids? None 0-5 years old 6-12 years old 13-18 years old 19 or older 103. >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 104. > Where are you in the divorce process? Please select your answer Considering divorce In the divorce process Divorced 105. Did you initiate the divorce? Please select your answer Yes No It was mutual 106. How long were you or have you been married? Please select your answer 0 to 5 years 6 to 10 years 11 to 15 years 16 to 20 years 21 years or more 107. How long ago did you get divorce or when do you expect to be divorced? Please select your answer 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 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) Please select your answer Yes No 110. Is there anything else you would like to share with us that might be helpful? Thank you for completing the self-assessment. An email with your results will be sent to you shortly! You are on your way to a better life! Email address Name Phone Number Time's up Leave a Reply Cancel replyYou must be logged in to post a comment.
