1.
Were you sexually abused as a child or adolescent?
Yes
No
2.
Did your parents have trouble with sexual behavior?
Yes
No
3.
Do you often find yourself preoccupied with sexual thoughts?
Yes
No
4.
Do you feel that your sexual behavior is not normal?
Yes
No
5.
Do you ever feel bad about your sexual behavior?
Yes
No
6.
Has your sexual behavior ever created problems for you and your family?
Yes
No
7.
Have you ever sought help for sexual behavior you did not like?
Yes
No
8.
Has anyone been hurt emotionally because of your sexual behavior?
Yes
No
9.
Are any of your sexual activities against the law?
Yes
No
10.
Have you made efforts to quit a type of sexual activity and failed?
Yes
No
11.
Do you hide some of your sexual behaviors from others?
Yes
No
12.
Have you attempted to stop some parts of your sexual activity?
Yes
No
13.
Have you felt degraded by your sexual behaviors?
Yes
No
14.
When you have sex, do you feel depressed afterwards?
Yes
No
15.
Do you feel controlled by your sexual desire?
Yes
No
16.
Have important parts of your life (such as job, family, friends, leisure activities) been neglected because you were spending too much time on sex?
Yes
No
17.
Do you ever think your sexual desire is stronger than you are?
Yes
No
18.
Is sex almost all you think about?
Yes
No
19.
Has sex (or romantic fantasies) been a way for you to escape your problems?
Yes
No
20.
Has sex become the most important thing in your life?
Yes
No
21.
Are you in crisis over sexual matters?
Yes
No
22.
The internet has created sexual problems for me.
Yes
No
23.
I spend too much time online for sexual purposes.
Yes
No
24.
I have purchased services online for erotic purposes (sites for dating)
Yes
No
25.
I have used the internet to make romantic or erotic connections with people online.
Yes
No
26.
People in my life have been upset about my sexual activities online.
Yes
No
27.
I have attempted to stop my online sexual behaviors.
Yes
No
28.
I have subscribed to or regularly purchased or rented sexually explicit materials (magazines, videos, books or online pornography).
Yes
No
29.
I have been sexual with minors.
Yes
No
30.
I have spent considerable time and money on strip clubs, adult bookstores and movie houses.
Yes
No
31.
I have engaged prostitutes and escorts to satisfy my sexual needs.
Yes
No
32.
I have spent considerable time surfing pornography online.
Yes
No
33.
I have used magazines, videos or online pornography even when there was considerable risk of being caught by family members who would be upset by my behavior.
Yes
No
34.
I have regularly purchased romantic novels or sexually explicit magazines.
Yes
No
35.
I have stayed in romantic relationships after they became emotionally abusive.
Yes
No
36.
I have traded sex for money or gifts.
Yes
No
37.
I have maintained multiple romantic or sexual relationships at the same time.
Yes
No
38.
After sexually acting out, I sometimes refrain from all sex for a significant period.
Yes
No
39.
I have regularly engaged in sadomasochistic behavior.
Yes
No
40.
I visit sexual bath-houses, sex clubs or video/bookstores as part of my regular sexual activity.
Yes
No
41.
I have engaged in unsafe or “risky” sex even though I knew it could cause me harm.
Yes
No
42.
I have cruised public restrooms, rest areas or parks looking for sex with strangers.
Yes
No
43.
I believe casual or anonymous sex has kept me from having more long-term intimate relationships.
Yes
No
44.
My sexual behavior has put me at risk for arrest for lewd conduct or public indecency.
Yes
No
45.
I have been paid for sex.
Yes
No