Anxious-Avoidant Relationship Pattern Assessment Form
Please complete this assessment to help identify patterns in your relationship attachment style. Answer each question as honestly as possible based on your typical experiences.
How comfortable do you feel with emotional closeness in relationships?
*
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
How often do you worry about your partner not wanting to be as close as you would like?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
When conflict arises in your relationship, how do you typically respond?
*
Seek closeness and reassurance
Withdraw or distance myself
Try to resolve calmly
Feel overwhelmed
Other
Rate your agreement with the following statements about your typical relationship experiences.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I worry my partner will leave me.
1
2
3
4
5
I find it difficult to trust others completely.
6
7
8
9
10
I prefer not to depend on others.
11
12
13
14
15
I feel anxious when my partner pulls away.
16
17
18
19
20
I am comfortable relying on others.
21
22
23
24
25
How likely are you to express your needs directly to your partner?
*
Not at all likely
1
2
3
4
Extremely likely
5
1 is Not at all likely, 5 is Extremely likely
How often do you feel the need for personal space in your relationships?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
When your partner is not available, how do you usually feel?
*
Secure and independent
Anxious or worried
Relieved or comfortable
Indifferent
Other
How would you rate your ability to communicate your feelings in a relationship?
*
1
2
3
4
5
How important is it for you to maintain independence in your relationships?
*
Not important
1
2
3
4
Very important
5
1 is Not important, 5 is Very important
Please share any additional comments or insights about your relationship patterns (optional).
Submit Assessment
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