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  1. ASSESSING THE DAMAGE Always usually sometimes rarely never SELF ESTEEM 1. I feel dirty, like there's something wrong with me - always 2. Sometimes I think I'm crazy - rarely 3. I feel ashamed-always 4. I'm different from other people- always 5. I feel powerless- rarely 6. If people really knew me, they'd leave- never 7. I want to die- sometimes 8. I want to kill myself-sometimes 9. I hate myself-usually 10. I have a hard time taking care of myself-sometimes 11. I don't deserve to be happy-never 12. I don't trust my intuition or my feelings-usually 13. I'm often confused-someties 14. I don't know how to set goals and follow through on them-sometimes 15. I'm scared of success-rarely 16. I'm a failure. I don't feel capable of doing a good job-sometimes 17. I use work to make up for empty feelings inside-usually 18. I'm a perfectionist-never 19. I've made up a lot of stories about my life-sometimes 20. I've done a lot of shoplifting-never MY FEELINGS 1. I don't think feelings are very important-never 2. I usually don't know what I'm feeling-rarely 3. I can't tell one feeling from another-sometimes 4. I only experience one or two emotions-always 5. I have a hard time expressing my feelings-rarely 6. I have a hard time crying freely-always 7. I cry all the time-never 8. I get uncomfortable when I feel too happy-always 9. I get nervous when things are relaxed and calm-sometimes 10. I feel enraged a lot of the time-rarely 11. I'm rarely angry. Anger scares me-usually 12. I get depressed a lot-usually 13. I have a lot of nightmares-rarely 14. I have panic attacks-rarely 15. If I really let myself go, my feelings would be out of control-sometimes 16. I've been violent-never 17. I haven't been violent yet, but I'm worried I might be-never MY BODY 1. I'm not "in my body" a lot of the time-sometimes 2. I frequently space out-sometimes 3. My body often feels numb-never 4. I feel as if my body is separate from the rest of me-rarely 5. I don't pay too much attention to my body's signals (hunger, tiredness, pain)-sometimes 6. I think my body is ugly-sometimes 7. I hide my body-sometimes 8. I'm dyslexic. I had learning disabilities when I was growing up-never 9. I use drugs or alcohol more than I think I should-rarely 10. I often eat compulsively-rarely 11. I keep myself from eating, or eat and throw up-never 12. I hurt myself on purpose (cut, burn or injure myself)-never 13. I have illnesses I think are related to my abuse-psychological maybe 14. I've worked out to make my body strong so I wouldn't feel like a victim-never 15. I've had flashbacks of the abuse during surgery or other medical procedures-never 16. I'm scared to go to the dentist. I hate the feeling of things in my mouth-never 17. (For women) I'm scared to go to the gynecologist INTIMACY 1. I often feel alienated from other people, as if I'm from another planet-always 2. Most of my relationships just don't work-rarely 3. I don't have many friends-usually 4. I'm okay with my friends, but I just can't work things out with a lover-never 5. I think I'm really meant to be alone- 6. I'm not sure I deserve to be loved-sometimes. 7. I don't know what love is-never 8. I find it hard to trust people-sometimes 9. I think people are going to leave me-rarely 10. I test people a lot-rarely 11. It's hard for me to be nurtured or to nurture someone else-usually 12. I'm clingy with people I'm close to. I'm afraid to be alone-sometimes 13. I'm scared of making commitment. When people get too close, I panic-rarely 14. I have a hard time saying no-usually 15. People take advantage of me in relationships-rarely 16. I get involved with people who are inappropriate or inaccessible-never 17. I've had relationships with people who remind me of my abuser-never 18. I'm struggling a lot with my partner-sometimes 19. Sometimes I think my partner is my abuser-never 20. Sexual abuse is really creating problems in my relationship-sometimes SEXUALITY 1. I avoid sex. Deep down, I wish I never had to deal with sex again-rarely 2. I am celibate. I haven't had sex in years-never 3. I really think sex is disgusting-sometimes 4. I don't feel sexual desire. I think there's something basically wrong with it-never 5. Sex isn't pleasurable for me. I usually have sex to make the other person happy-never 6. I try to use sex to meet most of my needs-never 7. It really feels like I'm "oversexed"-never 8. Sex and aggression are really connected for me-never 9. I find it hard to be close in nonsexual ways. It just isn't satisfying-never 10. I frequently go after sex I really don't want-never 11. Sex is the thing I'm best at-never 12. I've sold myself for sex-never 13. I've had sex with people who don't respect me-never 14. I need to control everything about sex-never 15. I have a hard time staying present when I make love. I'm numb a lot during lovemaking-never 16. When I am sexual, I have terrifying, scary feelings I don't understand-usually 17. I often have flashbacks of my abuse while making love.-sometimes 18. I get sexually aroused when I read or talk about sexual abuse-never 19. Violent, sadistic fantasies turn me on-never 20. I'm ashamed of my sexuality-never 21. I've sexually abused others-never CHILDREN AND PARENTING 1. I feel awkward and uncomfortable around children-rarely 2. I have a hard time being affectionate with kids- sometimes 3. I have a hard time setting boundaries with kids-sometimes 4. I have a hard time balancing children's needs with my own. n/a 5. (For parents) I feel inadequate as a parent. 6. I have trouble protecting children I take care of-n/a 7. I tend to be overprotective-sometimes 8. I've successfully protected children-n/a 9. I'm scared I'll be abusive-never 10. I have abused children-never 11. My kids have been abused (by someone else)n/a MY FAMILY OF ORIGIN 1. I have strained relationships with my family-never 2. Members of my family have rejected me (or vice versa)-never 3. I have a hard time setting limits with my family-never 4. People in my family invalidate my feelings and experiences-never 5. I feel crazy when I'm around my family-sometimes 6. I can't be honest with the people in my family-always 7. My abuse is still a secret in my family-always 8. I'm waiting for people in my family to come around and support me-never 1. When I look over my responses, I feel... the same. 2. I've been most strongly affected in the areas of... SELF ESTEEM 3. I was least affected in the areas of...Sexuality 4. The hardest statements for me to acknowledge were...I want to die/kill myself 5. I feel the most hopeful about making changes self esteem 6. I already made major strides in the following areas...n/a 7. I feel the most hopeless about changing... what I think about myself 8. I was surprised not far I've come. 9. I learned...