Sex and Love Addiction Self-Assessment Questionnaire Form
Reflect on your behaviors and feelings with this brief self-assessment. Your responses are private and for your personal insight only.
How often do you find yourself preoccupied with thoughts of sex or romantic relationships?
*
Never
1
2
3
4
Very Often
5
1 is Never, 5 is Very Often
Do you feel distress or anxiety when you are not in a relationship or pursuing romantic attention?
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
How frequently do you engage in sexual or romantic behaviors to escape feelings of loneliness, stress, or boredom?
*
Never
1
2
3
4
Very Frequently
5
1 is Never, 5 is Very Frequently
Have you ever continued sexual or romantic behaviors despite negative consequences (e.g., relationship issues, work problems, emotional distress)?
*
Yes
No
Prefer not to say
To what extent do you feel your sexual or romantic behaviors are outside of your control?
*
Not at all
1
2
3
4
Completely
5
1 is Not at all, 5 is Completely
How often do you neglect important responsibilities (work, family, personal care) because of time spent on sexual or romantic pursuits?
*
Never
1
2
3
4
Very Often
5
1 is Never, 5 is Very Often
Have you tried to reduce or control your sexual or romantic behaviors, but found it difficult?
*
Yes
No
How much do these behaviors impact your emotional well-being or sense of self-worth?
*
Not at all
1
2
3
4
A great deal
5
1 is Not at all, 5 is A great deal
Do you often feel guilt or shame after sexual or romantic activities?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Is seeking new sexual or romantic experiences a frequent priority over other aspects of your life?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
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