| *** 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. |
all right |
| *** You may choose more than one in each category *** |
| 2. but answer as simply as possible. |
yes |
| 3. If you would like to write an explanation for your answers, you may. |
No Answer |
| 4. All responses will be kept confidential. |
good |
| *** Self-Image: *** |
| 5. I am a Hottie |
no |
| 6. I am Eye Candy |
no |
| 7. I am Beautiful |
no |
| 8. I am Good Looking |
yes |
| 9. I am Okay |
yes |
| 10. I am Not Attractive |
no |
| 11. I am Fat |
yes |
| 12. I am a MILF |
No Answer |
| 13. Other:___________ |
No Answer |
| *** I Dress the Way I Do, Because: *** |
| 14. I feel like it |
yes |
| 15. I want to |
yes |
| 16. I need to |
yes |
| 17. I feel powerful when I do |
No Answer |
| 18. I love what I wear |
like it |
| 19. I like the response I get, even if it's not the response I want |
yes |
| 20. Other:___________ |
No Answer |
| *** I Like It When: *** |
| 21. Men look at my Pictures on MySpace |
no |
| 22. Men get "excited" over my pictures on MySpace |
no |
| 23. Men relate to me as a desirable female |
No Answer |
| 24. Men leave me messages about how "Hot" I am |
no |
| 25. Men pay any attention at all to me |
yes |
| 26. Men leave me alone |
yes |
| 27. Other:___________ |
No Answer |
| *** It Bothers Me When: *** |
| 28. I am posing in a way to illicit a response from men in pictures |
would |
|
|
| 29. I men judge me as an object |
no |
| 30. I am treated as less than special |
no |
| 31. People don't seem to see the "real me" |
no |
| 32. Other:___________ |
No Answer |
| *** I am Happiest When: *** |
| 33. I am appreciated |
yes |
| 34. I am treated with respect |
yes |
| 35. I am acknowledged |
yes |
| 36. I am loved |
yes |
| 37. I am sexy |
eh |
| 38. I am shopping |
no |
| 39. I am successful |
yes |
| 40. Other:___________ |
No Answer |
| *** What I Need Most in Life to Feel Fulfilled is: *** |
| 41. Love |
yes |
| 42. Respect |
yes |
| 43. Happiness |
yes |
| 44. Sex |
no |
| 45. Money |
some |
| 46. Clothes |
have them |
| 47. A Hug |
yes |
| 48. Other:___________ |
No Answer |
| *** The Biggest "Pain" I Deal With is Because I was/Have Been *** |
| 49. Lied to |
yes |
| 50. Hurt |
yes |
| 51. Abandoned |
yes |
| 52. Injured |
yes |
| 53. Raped |
yes |
| 54. Victimized as a Child |
several times |
| 55. Heartbroken |
yes |
| 56. Other:___________ |
No Answer |
|
|
| *** I deal with the Following: *** |
| 57. Addiction to medications/drugs (prescription or otherwise) |
yes pot |
| 58. Alcohol |
yes |
| 59. Over-eating |
yes |
| 60. Temper/Anger |
no |
| 61. Depression |
yes |
| 62. Other:___________ |
No Answer |
| *** My Biggest Fear Is: *** |
| 63. I won’t be a success |
yes |
| 64. I won’t be taken seriously |
yes |
| 65. I’ll go unnoticed |
no |
| 66. I won't be a good wife |
yes |
| 67. I won't be a good mother |
yes |
| 68. I will never find a partner in life |
I have the best there is |
| 69. I made a mistake getting together with the one I'm with (married or not) |
NO |
| 70. I will never get married |
already am |
| 71. I will never find a partner who is "worthy of me" |
alredy did |
| 72. I am not worthy of being loved by someone |
no |
| 73. My children will not be well adjusted |
no |
| 74. I am going to hurt my children |
no |
| 75. I am going to hurt myself (or hurt myself again) |
no |
| 76. I am a powerful person |
no |
| 77. I will be successful |
yes |
| 78. I will not know how to handle success when it comes |
yes |
| 79. I am afraid of people |
some |
| 80. I am afraid of going outside |
no |
| 81. I am afraid of speaking in public |
yes |
| 82. I am afraid of being raped (or raped again) |
no |
| 83. Other:___________ (see this list for some examples: http://www.phobialist.com/reverse.html) |
No Answer |
| *** I Prefer the Company of: *** |
| 84. Men |
yes |
|
|
| 85. Women |
yes |
| 86. Teens |
no |
| 87. Children |
depends |
| 88. Girls |
yes |
| 89. Boys |
yes |
| 90. Elderly |
yes |
| 91. Other:___________ |
No Answer |
| *** I My Perfect World I Would Be: *** |
| 92. A Model |
no |
| 93. A Singer/Musician |
no |
| 94. An Actor |
no |
| 95. A Director |
no |
| 96. A Manager |
no |
| 97. A Mother |
already am |
| 98. A Bride |
was 13 1/2 yrs ago |
| 99. Loved by Anyone |
i am |
| 100. Loved by Someone |
i am |
| 101. Find love that was real and lasting |
i have |
| 102. Other:___________ |
No Answer |
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