1. Believe you would be happy if only the sex addict would change? 1. Believe you would be happy if only the sex addict would change? Yes No

2. Sometimes look at other families, imagine that they are ‘normal,’ and wish your relationship could be happy like theirs? 2. Sometimes look at other families, imagine that they are ‘normal,’ and wish your relationship could be happy like theirs? Yes No

3. Feel pressured to become sexual with partners before you know them very well, or done so repeatedly in order to avoid abandonment? 3. Feel pressured to become sexual with partners before you know them very well, or done so repeatedly in order to avoid abandonment? Yes No

4. Become physically affected by another person’s compulsive sexual behavior and contracted stress-related illnesses, STDs, or have a baby or an abortion to fix the relationship? 4. Become physically affected by another person’s compulsive sexual behavior and contracted stress-related illnesses, STDs, or have a baby or an abortion to fix the relationship? Yes No

5. Engage in compulsive, self-destructive or depressive behaviors to avoid your feelings? 5. Engage in compulsive, self-destructive or depressive behaviors to avoid your feelings? Yes No

6. Sometimes feel crazy or numb and have a hard time separating the truth from lies when talking to the sex addict? 6. Sometimes feel crazy or numb and have a hard time separating the truth from lies when talking to the sex addict? Yes No

7. Feel immense shame about the sex addict’s behaviors, attributing it as a reflection on you or your family? 7. Feel immense shame about the sex addict’s behaviors, attributing it as a reflection on you or your family? Yes No

8. Believe if only you could help the sex addict with their pain, they would get better? 8. Believe if only you could help the sex addict with their pain, they would get better? Yes No

9. Put the sex addict’s needs before your own? 9. Put the sex addict’s needs before your own? Yes No

10. Feel happy when the sex addict is happy and doing well, and struggle when the sex addict is sad, angry, or struggling? 10. Feel happy when the sex addict is happy and doing well, and struggle when the sex addict is sad, angry, or struggling? Yes No

11. Spend time worrying about where the sex addict is, who they might be with, what they might be doing? 11. Spend time worrying about where the sex addict is, who they might be with, what they might be doing? Yes No

12. “Snoopervise” – Spend time searching for clues to the sex addict’s acting out? Check personal space, computers, cars, bank records, phone bills, laundry for clues to the addictive sexual behavior of the addict? 12. “Snoopervise” – Spend time searching for clues to the sex addict’s acting out? Check personal space, computers, cars, bank records, phone bills, laundry for clues to the addictive sexual behavior of the addict? Yes No

13. Find yourself hyper-focused on the sex addict’s level of recovery? 13. Find yourself hyper-focused on the sex addict’s level of recovery? Yes No

14. Avoid ever speaking with others (close friends, a professional counselor or sponsor) about your sexual behaviors or feelings? 14. Avoid ever speaking with others (close friends, a professional counselor or sponsor) about your sexual behaviors or feelings? Yes No

15. Focus more on another person’s sexual attitudes, beliefs, or needs than your own? 15. Focus more on another person’s sexual attitudes, beliefs, or needs than your own? Yes No

16. Allow sexual activities with your partner which feel unpleasant, painful, scary, degrading or shaming to you, yet you don’t set boundaries for yourself? 16. Allow sexual activities with your partner which feel unpleasant, painful, scary, degrading or shaming to you, yet you don’t set boundaries for yourself? Yes No

17. Withdraw emotionally, have your mind on other things during sex, or feel empty afterwards? 17. Withdraw emotionally, have your mind on other things during sex, or feel empty afterwards? Yes No

18. Have less interest in and awareness of your own sexual needs and desires, than the sex addict’s sexual needs and desires? 18. Have less interest in and awareness of your own sexual needs and desires, than the sex addict’s sexual needs and desires? Yes No

Can we contact you for a follow up? Can we contact you for a follow up? Yes please No thank you

Name

Phone

Email Address

Message