| *** These question are serious and will help in writing several articles and a book I am preparing. *** |
| 1. Please rate the following statements by how you would apply them to yourself, and as honestly as possible. |
No Answer |
| *** You may choose more than one in each category *** |
| 2. but answer as simply as possible. |
No Answer |
| 3. If you would like to write an explanation for your answers, you may. |
No Answer |
| 4. All responses will be kept confidential. |
No Answer |
| *** Self-Image: *** |
| 5. I am a Hottie |
Does not apply |
| 6. I am Eye Candy |
Does not apply |
| 7. I am Beautiful |
Some would say so |
| 8. I am Good Looking |
I think so |
| 9. I am Okay |
better than ok |
| 10. I am Not Attractive |
not true |
| 11. I am Fat |
nope |
| 12. I am a MILF |
what the heck is a MILF?? |
| 13. Other:___________ |
No Answer |
| *** I Dress the Way I Do, Because: *** |
| 14. I feel like it |
Yep |
| 15. I want to |
Yep |
| 16. I need to |
nope |
| 17. I feel powerful when I do |
sometimes |
| 18. I love what I wear |
sometimes |
| 19. I like the response I get, even if it's not the response I want |
does not apply |
| 20. Other:___________ |
No Answer |
| *** I Like It When: *** |
| 21. Men look at my Pictures on MySpace |
Doesn't matter |
| 22. Men get "excited" over my pictures on MySpace |
doesn't matter to me |
| 23. Men relate to me as a desirable female |
that's always nice |
| 24. Men leave me messages about how "Hot" I am |
does not apply |
| 25. Men pay any attention at all to me |
that's always nice |
| 26. Men leave me alone |
no problem with that |
| 27. Other:___________ |
No Answer |
| *** It Bothers Me When: *** |
| 28. I am posing in a way to illicit a response from men in pictures |
don't do that |
|
|
| 29. I men judge me as an object |
never happens |
| 30. I am treated as less than special |
yep that bothers me |
| 31. People don't seem to see the "real me" |
yep that bothers me |
| 32. Other:___________ |
No Answer |
| *** I am Happiest When: *** |
| 33. I am appreciated |
very much so |
| 34. I am treated with respect |
very much so |
| 35. I am acknowledged |
very much so |
| 36. I am loved |
very much so |
| 37. I am sexy |
that's nice |
| 38. I am shopping |
I enjoy shopping |
| 39. I am successful |
very much so |
| 40. Other:___________ |
No Answer |
| *** What I Need Most in Life to Feel Fulfilled is: *** |
| 41. Love |
very important |
| 42. Respect |
very important |
| 43. Happiness |
I am happy |
| 44. Sex |
nice but not necessary |
| 45. Money |
necessary for life |
| 46. Clothes |
I'm a clothes horse |
| 47. A Hug |
absolutely |
| 48. Other:___________ |
No Answer |
| *** The Biggest "Pain" I Deal With is Because I was/Have Been *** |
| 49. Lied to |
Big problem |
| 50. Hurt |
Big problem |
| 51. Abandoned |
getting over that |
| 52. Injured |
suffering physically from 6 operations on my spine |
| 53. Raped |
As a child yes, have learned to deal with that |
| 54. Victimized as a Child |
yes |
| 55. Heartbroken |
yes |
| 56. Other:___________ |
Hasn't everyone dealt with most of these? |
|
|
| *** I deal with the Following: *** |
| 57. Addiction to medications/drugs (prescription or otherwise) |
no |
| 58. Alcohol |
no |
| 59. Over-eating |
no |
| 60. Temper/Anger |
no |
| 61. Depression |
sometimes |
| 62. Other:___________ |
No Answer |
| *** My Biggest Fear Is: *** |
| 63. I won’t be a success |
a fear but not the biggest |
| 64. I won’t be taken seriously |
I'm always taken seriously |
| 65. I’ll go unnoticed |
I'm usually noticed |
| 66. I won't be a good wife |
been there, done that |
| 67. I won't be a good mother |
been there, done that |
| 68. I will never find a partner in life |
that would be fabulous |
| 69. I made a mistake getting together with the one I'm with (married or not) |
not with anyone |
| 70. I will never get married |
not really a fear, been there, done that |
| 71. I will never find a partner who is "worthy of me" |
silly question |
| 72. I am not worthy of being loved by someone |
silly question |
| 73. My children will not be well adjusted |
my children are grown and well adjusted |
| 74. I am going to hurt my children |
no way |
| 75. I am going to hurt myself (or hurt myself again) |
no |
| 76. I am a powerful person |
how could this be a fear? |
| 77. I will be successful |
fear of success? no way! I'm looking forward to it! |
| 78. I will not know how to handle success when it comes |
not a fear |
| 79. I am afraid of people |
not a fear |
| 80. I am afraid of going outside |
no way |
| 81. I am afraid of speaking in public |
nope |
| 82. I am afraid of being raped (or raped again) |
nope |
| 83. Other:___________ (see this list for some examples: http://www.phobialist.com/reverse.html) |
fear of dying alone |
| *** I Prefer the Company of: *** |
| 84. Men |
I prefer men but always enjoy the company of women |
|
|
| 85. Women |
No Answer |
| 86. Teens |
No Answer |
| 87. Children |
No Answer |
| 88. Girls |
No Answer |
| 89. Boys |
No Answer |
| 90. Elderly |
No Answer |
| 91. Other:___________ |
No Answer |
| *** I My Perfect World I Would Be: *** |
| 92. A Model |
No Answer |
| 93. A Singer/Musician |
No Answer |
| 94. An Actor |
I am an actor |
| 95. A Director |
No Answer |
| 96. A Manager |
No Answer |
| 97. A Mother |
No Answer |
| 98. A Bride |
No Answer |
| 99. Loved by Anyone |
No Answer |
| 100. Loved by Someone |
still searching for that illusive someone |
| 101. Find love that was real and lasting |
yep definitely.....see #83 |
| 102. Other:___________ |
No Answer |