Yes [ ] No [ ] 1.) Have you ever tried to control how much sex to have or how often you would see someone?
Yes [ ] No [ ] 2.) Do you find yourself unable to stop seeing a specific person even though you know that seeing this person is destructive to you?
Yes [ ] No [ ] 3.) Do you feel that you don't want anyone to know about your sexual or romantic activities?
Yes [ ] No [ ] 4.) Do you get "high" from sex and/or romance?
Yes [ ] No [ ] 5.) Have you had sex at inappropriate times, in inappropriate places, and/or with inappropriate people?
Yes [ ] No [ ] 6.) Do you make promises to yourself concerning your sexual or romantic behavior that you find you cannot follow?
Yes [ ] No [ ] 7.) Have you had or do you have sex with someone you don't (didn't) want to have sex with?
Yes [ ] No [ ] 8.) Do you believe that sex and/or a relationship will make your life bearable?
Yes [ ] No [ ] 9.) Have you ever felt that you had to have sex?
Yes [ ] No [ ] 10.) Do you believe that someone can "fix" you?
Yes [ ] No [ ] 11.) Do you keep a list, written or otherwise, of the number of partners you've had?
Yes [ ] No [ ] 12.) Do you feel desperation or uneasiness when you are away from your lover or sexual partner?
Yes [ ] No [ ] 13.) Have you lost count of the number of sexual partners you've had?
Yes [ ] No [ ] 14.) Do you feel desperate about your need for a lover, sexual fix, or future mate?
Yes [ ] No [ ] 15.) Have you or do you have sex regardless of the consequences (e.g.. the threat of being caught, the risk of contracting herpes, gonorrhea, AIDS, etc.)?
Yes [ ] No [ ] 16.) Do you find that you have a pattern of repeating bad relationships?
Yes [ ] No [ ] 17.) Do you feel that your only (or major) value in a relationship is your ability to perform sexually, or provide an emotional fix?
Yes [ ] No [ ] 18.) Do you feel that you're not "really alive" unless you are with your sexual / romantic partner?
Yes [ ] No [ ] 19.) Do you feel entitled to sex?
Yes [ ] No [ ] 20.) Do you find yourself in a relationship that you cannot leave?
Yes [ ] No [ ] 21.) Have you ever threatened your financial stability or standing in the community by pursuing a sexual partner?
Yes [ ] No [ ] 22.) Do you believe that the problems in your "love life" result from continuing to remain with the "wrong" person?
Yes [ ] No [ ] 23.) Have you ever had a serious relationship threatened or destroyed because of outside sexual activity?
Yes [ ] No [ ] 24.) Do you feel that life would have no meaning without a love relationship or without sex?
Yes [ ] No [ ] 25.) Do you find yourself flirting or sexualizing with someone even if you do not mean to?
Yes [ ] No [ ] 26.) Does your sexual and/or romantic behavior affect your reputation?
Yes [ ] No [ ] 27.) Do you have sex and/or "relationships" to try to deal with, or escape from life's problems?
Yes [ ] No [ ] 28.) Do you feel uncomfortable about your masturbation because of the frequency with which you masturbate, the fantasies you engage in, the props you use, and/or the places in which you do it?
Yes [ ] No [ ] 29.) Do you engage in the practice of voyeurism, exhibitionism, etc. in ways that bring discomfort and pain?
Yes [ ] No [ ] 30.) Do you find yourself needing greater and greater variety and energy in your sexual or romantic activities just to achieve an "acceptable" level of physical and emotional relief?
Yes [ ] No [ ] 31.) Do you need to have sex, or "fall in love" in order to feel like a "real man" or a "real woman"?
Yes [ ] No [ ] 32.) Do you feel that your sexual and romantic behavior is about as rewarding as hijacking a revolving door?
Yes [ ] No [ ] 33.) Are you unable to concentrate on other areas of your life because of thoughts or feelings you are having about another person or about sex?
Yes [ ] No [ ] 34.) Do you find yourself obsessing about a specific person or sexual act even though these thoughts bring pain, craving or discomfort?
Yes [ ] No [ ] 35.) Have you ever wished you could stop or control your sexual and romantic activities for a given period of time?
Yes [ ] No [ ] 36.) Do you find the pain in your life increasing no matter what you do?
Yes [ ] No [ ] 37.) Do you feel that you lack dignity and wholeness?
Yes [ ] No [ ] 38.) Do you feel that your sexual and/or romantic life affects your spiritual life in a negative way?
Yes [ ] No [ ] 39.) Do you feel that your life is unmanageable because of your excessive dependency needs?
Yes [ ] No [ ] 40.) Have you ever thought that there might be more you could do with your life if you were not so driven by sexual and romantic pursuits?