Fisher Divorce Adjustment Survey 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. Click Next to get started 1. I am comfortable telling people I am separated from my love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never2. I am physically and emotionally exhausted from morning until nightAlmost AlwaysUsuallySometimesSeldomAlmost Never3. I am constantly thinking of my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never4. I feel rejected by many of the friends I had when I was in the love relationshipAlmost AlwaysUsuallySometimesSeldomAlmost Never5. I become upset when I think about my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never6. I like being the person I amAlmost AlwaysUsuallySometimesSeldomAlmost Never7. I feel like crying because I feel so sadAlmost AlwaysUsuallySometimesSeldomAlmost Never8. I can communicate with my former love partner in a calm and rational mannerAlmost AlwaysUsuallySometimesSeldomAlmost Never9. There are many things about my personality I would like to changeAlmost AlwaysUsuallySometimesSeldomAlmost Never10. It is easy for me to accept my becoming a single personAlmost AlwaysUsuallySometimesSeldomAlmost Never11. I feel depressedAlmost AlwaysUsuallySometimesSeldomAlmost Never12. I feel emotionally separated from my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never13. People would not like me if they got to know meAlmost AlwaysUsuallySometimesSeldomAlmost Never14. I feel comfortable seeing and talking to my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never15. I feel like I am an attractive personAlmost AlwaysUsuallySometimesSeldomAlmost Never16. I feel as though I am in a daze and the world doesn't seem realAlmost AlwaysUsuallySometimesSeldomAlmost Never17. I find myself doing things just to please my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never18. I feel lonelyAlmost AlwaysUsuallySometimesSeldomAlmost Never19. There are many things about my body I would like to changeAlmost AlwaysUsuallySometimesSeldomAlmost Never20. I have many plans and goals for the futureAlmost AlwaysUsuallySometimesSeldomAlmost Never21. I feel I don't have much sex appealAlmost AlwaysUsuallySometimesSeldomAlmost Never22. I am relating and interacting in many new ways with people since my separationAlmost AlwaysUsuallySometimesSeldomAlmost Never23. Joining a singles group would make me feel I was a loser like themAlmost AlwaysUsuallySometimesSeldomAlmost Never24. It is easy for me to organize my daily routine of livingAlmost AlwaysUsuallySometimesSeldomAlmost Never25. I find myself making excuses to see and talk to my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never26. Because my love relationship failed, I must be a failureAlmost AlwaysUsuallySometimesSeldomAlmost Never27. I feel like unloading my feelings of anger and hurt upon my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never28. I feel comfortable being with peopleAlmost AlwaysUsuallySometimesSeldomAlmost Never29. I have trouble concentratingAlmost AlwaysUsuallySometimesSeldomAlmost Never30. I think of my former love partner as related to me rather than as a separate personAlmost AlwaysUsuallySometimesSeldomAlmost Never31. I feel like an okay personAlmost AlwaysUsuallySometimesSeldomAlmost Never32. I hope my former love partner is feeling as much or more emotional pain than I amAlmost AlwaysUsuallySometimesSeldomAlmost Never33. I have close friends who know and understand meAlmost AlwaysUsuallySometimesSeldomAlmost Never34. I am unable to control my emotionsAlmost AlwaysUsuallySometimesSeldomAlmost Never35. I feel capable of building a deep and meaningful love relationshipAlmost AlwaysUsuallySometimesSeldomAlmost Never36. I have trouble sleepingAlmost AlwaysUsuallySometimesSeldomAlmost Never37. I easily become angry at my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never38. I am afraid to trust people who might become love partnersAlmost AlwaysUsuallySometimesSeldomAlmost Never39. Because my love relationship ended, I feel there must be something wrong with meAlmost AlwaysUsuallySometimesSeldomAlmost Never40. I either have no appetite or eat continuously which is unusual for meAlmost AlwaysUsuallySometimesSeldomAlmost Never41. I don't want to accept the fact that our love relationship is endingAlmost AlwaysUsuallySometimesSeldomAlmost Never42. I force myself to eat even though I'm not hungryAlmost AlwaysUsuallySometimesSeldomAlmost Never43. I have given up on my former love partner and getting back togetherAlmost AlwaysUsuallySometimesSeldomAlmost Never44. I feel very frightened insideAlmost AlwaysUsuallySometimesSeldomAlmost Never45. It is important that my family, friends, and associates be on my side rather than on my former love partner's sideAlmost AlwaysUsuallySometimesSeldomAlmost Never46. I feel uncomfortable even thinking about datingAlmost AlwaysUsuallySometimesSeldomAlmost Never47. I feel capable of living the kind of life I would like to liveAlmost AlwaysUsuallySometimesSeldomAlmost Never48. I have noticed my body weight is changing a great dealAlmost AlwaysUsuallySometimesSeldomAlmost Never49. I believe if we try, my love partner and I can save our love relationshipAlmost AlwaysUsuallySometimesSeldomAlmost Never50. My abdomen feels empty and hollowAlmost AlwaysUsuallySometimesSeldomAlmost Never51. I have feelings of romantic love for my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never52. I can make the decisions I need to because I know and trust my feelingsAlmost AlwaysUsuallySometimesSeldomAlmost Never53. I would like to get even with my former love partner for hurting meAlmost AlwaysUsuallySometimesSeldomAlmost Never54. I avoid people even though I want and need friendsAlmost AlwaysUsuallySometimesSeldomAlmost Never55. I have really made a mess of my lifeAlmost AlwaysUsuallySometimesSeldomAlmost Never56. I sigh a lotAlmost AlwaysUsuallySometimesSeldomAlmost Never57. I believe it is best for all concerned to have our love relationship endAlmost AlwaysUsuallySometimesSeldomAlmost Never58. I perform my daily activities in a mechanical and unfeeling mannerAlmost AlwaysUsuallySometimesSeldomAlmost Never59. I become upset when I think about my love partner having a love relationship with someone elseAlmost AlwaysUsuallySometimesSeldomAlmost Never60. I feel capable of facing and dealing with my problemsAlmost AlwaysUsuallySometimesSeldomAlmost Never61. I blame my former love partner for the failure of our love relationshipAlmost AlwaysUsuallySometimesSeldomAlmost Never62. I am afraid of becoming sexually involved with another personAlmost AlwaysUsuallySometimesSeldomAlmost Never63. I feel adequate as a fe/male love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never64. It will only be a matter of time until my love partner and I get back togetherAlmost AlwaysUsuallySometimesSeldomAlmost Never65. I feel detached and removed from activities around me as though I were watching them on a movie screenAlmost AlwaysUsuallySometimesSeldomAlmost Never66. I would like to continue having a sexual relationship with my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never67. Life is somehow passing me byAlmost AlwaysUsuallySometimesSeldomAlmost Never68. I feel comfortable going by myself to a public place such as a movieAlmost AlwaysUsuallySometimesSeldomAlmost Never69. It is good to feel alive again after having felt numb and emotionally deadAlmost AlwaysUsuallySometimesSeldomAlmost Never70. I feel I know and understand myselfAlmost AlwaysUsuallySometimesSeldomAlmost Never71. I feel emotionally committed to my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never72. I want to be with people but I feel emotionally distant from themAlmost AlwaysUsuallySometimesSeldomAlmost Never73. I am the type of person I would like to have for a friendAlmost AlwaysUsuallySometimesSeldomAlmost Never74. I am afraid of becoming emotionally close to another love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never75. Even on the days when I am feeling good, I may suddenly become sad and start cryingAlmost AlwaysUsuallySometimesSeldomAlmost Never76. I can't believe our love relationship is endingAlmost AlwaysUsuallySometimesSeldomAlmost Never77. I become upset when I think about my love partner dating someoneAlmost AlwaysUsuallySometimesSeldomAlmost Never78. I have a normal amount of self-confidenceAlmost AlwaysUsuallySometimesSeldomAlmost Never79. People seem to enjoy being with meAlmost AlwaysUsuallySometimesSeldomAlmost Never80. Morally and spiritually, I believe it is wrong for our love relationship to endAlmost AlwaysUsuallySometimesSeldomAlmost Never81. I wake up in the morning feeling there is no good reason to get out of bedAlmost AlwaysUsuallySometimesSeldomAlmost Never82. I find myself daydreaming about all the good times I had with my love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never83. People want to have a love relationship with me because I feel like a lovable personAlmost AlwaysUsuallySometimesSeldomAlmost Never84. I want to hurt my former love partner by letting him/her know how much I hurt emotionallyAlmost AlwaysUsuallySometimesSeldomAlmost Never85. I feel comfortable going to social events even though I am singleAlmost AlwaysUsuallySometimesSeldomAlmost Never86. I feel guilty about my love relationship endingAlmost AlwaysUsuallySometimesSeldomAlmost Never87. I feel emotionally insecureAlmost AlwaysUsuallySometimesSeldomAlmost Never88. I feel uncomfortable even thinking about having a sexual relationshipAlmost AlwaysUsuallySometimesSeldomAlmost Never89. I feel emotionally weak and helplessAlmost AlwaysUsuallySometimesSeldomAlmost Never90. I think about ending my life with suicideAlmost AlwaysUsuallySometimesSeldomAlmost Never91. I understand the reasons why our love relationship did not work outAlmost AlwaysUsuallySometimesSeldomAlmost Never92. I feel comfortable having my friends know our love relationship is endingAlmost AlwaysUsuallySometimesSeldomAlmost Never93. I am angry about the things my former love partner has been doingAlmost AlwaysUsuallySometimesSeldomAlmost Never94. I feel like I am going crazyAlmost AlwaysUsuallySometimesSeldomAlmost Never95. I am unable to perform sexuallyAlmost AlwaysUsuallySometimesSeldomAlmost Never96. I feel as though I am the only single person in a couples-only societyAlmost AlwaysUsuallySometimesSeldomAlmost Never97. I feel like a single person rather than a married personAlmost AlwaysUsuallySometimesSeldomAlmost Never98. I feel my friends look at me as unstable now that I'm separatedAlmost AlwaysUsuallySometimesSeldomAlmost Never99. I daydream about being with and talking to my former love partnerAlmost AlwaysUsuallySometimesSeldomAlmost Never100. I need to improve my feelings of self-worth about being a wo/manAlmost AlwaysUsuallySometimesSeldomAlmost Never101. What is your gender?FemaleMalePrefer not to say102. What ages are your children (if any)?>Do you have kids? None 0-5 years old 6-12 years old 13-18 years old 19 or older103. >What do you do during normal work hours?Stay at home parentPhysical/Active type of jobManagerial jobDesk JobNot currently working/Other104. > Where are you in the divorce process?Please select your answerConsidering divorceIn the divorce processDivorced105. Did you initiate the divorce?Please select your answerYesNoIt was mutual106. How long were you or have you been married?Please select your answer0 to 5 years6 to 10 years11 to 15 years16 to 20 years21 years or more107. How long ago did you get divorce or when do you expect to be divorced?Please select your answer0 to 1 year ago1 -2 years ago2-5 years ago6 or more years agoIn the next monthSometime this yearNot sure108. 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 answerYesNo110. 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 is Up!
