1. Do you find it difficult to trust your partner?
2. Do you have moments of unexplainable anger, coldness, or indifference towards your partner?
A. Yes, it seems like a part of me is shut down
B. Rarely, but I easily come back to my normal state of mind
C. No, there is always a reason whenever I feel such emotions
3. Are you able to express your emotions and share your feelings or personal thoughts before your partner?
A. No, I get very uncomfortable and fearful, so I often keep them to myself
B. Yes, but I may feel a barrier sometimes
C. Yes, I can be completely vulnerable with them
4. Do you live in self-imposed isolation?
A. Yes, I do now, or have done it in the past
B. No, I need to be among people at least for a while
C. No, I haven’t had such periods
5. Does physical contact cause you discomfort?
A. Yes, I often struggle to feel pleasure during sexual activities and seek distance from others
B. I do not like to be touched a lot, but it’s nothing serious
C. No, I feel pretty comfortable with physical contact of any kind
6. Do you have inhibited sexual desire and difficulty being aroused or unsatiable sex hunger?
B. I may find it hard to get in the mood sometimes, but sex is great afterward
7. What is your relationship history?
A. I have had too many or too few unstable relationships
B. I have not had that many relationships, but they are relatively stable
C. I have had a few long-term, stable relationships
8. Did you have trouble forming them or committing to them?
B. I may have been a bit distant only in the beginning, but not afterward
9. Do you fear being rejected or hurt by your partner?
A. Yes, and I find it hard to keep these thoughts off my mind
B. I sometimes think about that but do not feel that scared
C. No, these thoughts rarely come to mind and do not give me such discomfort
10. What is your attitude towards self and others?
A. I am very doubtful of my capabilities and my relationships with others and sometimes devalue myself too much
B. I am aware of my capabilities and know my self-worth; I may be a bit distrustful of others sometimes
C. I am confident with what I can do and where my relationships stand, I take good care of myself