- Do
you keep secrets about your sexual behavior or romantic fantasies from
those important to you? Do you lead a double life?
Yes_____ No_____ - Have
your desires driven you to have sex in places or with people you would
not normally choose?
Yes_____ No_____ - Do
you need greater variety, increased frequency, or more extreme sexual
activities to achieve the same level of excitement or relief?
Yes_____ No_____ - Does
your use of pornography occupy large amounts of time and/or jeopardize
your significant relationships or employment?
Yes_____ No_____ - Do
your relationships become distorted with sexual preoccupation? Does
each new relationship have the same destructive pattern which prompted
you to leave the last one?
Yes_____ No_____ - Do
you frequently want to get away from a partner after having sex? Do you
feel remorse, shame, or guilt after a sexual encounter?
Yes_____ No_____ - Have
your sexual practices caused you legal problems? Could your sexual
practices cause you legal problems?
Yes_____ No_____ - Does
your pursuit of sex or sexual fantasy conflict with your moral
standards or interfere with your personal spiritual journey?
Yes_____ No_____ - Do
your sexual activities involve coercion, violence, or the threat of
disease?
Yes_____ No_____ - Has
your sexual behavior or pursuit of sexual relationships ever left you
feeling hopeless, alienated from others, or suicidal?
Yes_____ No_____ - Does
your preoccupation with sexual fantasies cause problems in any area of
your life - even when you do not act out your fantasies?
Yes_____ No_____ - Do
you compulsively avoid sexual activity due to fear of sex or intimacy?
Does your sexual avoidance consume you mentally?
Yes_____ No_____
