I often feel a sense of heaviness or fatigue when I am around my spouse, as if my energy has been drained.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I often distract myself with television or my phone or act like there isn't a problem
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I feel a constant, underlying sense of anxiety or unease in my body, even when there is no immediate conflict with my spouse.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I have trouble falling asleep or staying asleep because of worries about our relationship or children.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I find myself turning to food, alcohol, shopping, or other coping mechanisms to "check out" or disengage from life.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I have secretly wished my spouse would disappear or die so I wouldn't have to deal with my relationship.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I find myself having feelings at all or can barely remember what it's like to feel feelings.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Do you often second guess your own memories or feel like you’re going crazy because of your spouse’s version of events?
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My partner sometimes uses silence to "punish" or "discipline" me.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My body feels tension when they walk in the room
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My partner will sometimes engage in hostile looks in my direction or will intentionally NOT look at me at all.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I don't enjoy my marital relationship; I just tolerate it.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
If there weren't some obstacles, I would definitely get a divorce.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I feel selfish when I have needs or desires and rarely or never put them ahead of my partner's
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I feel loved and even worshipped during intimacy with my partner.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I am uncomfortable with the word "worshipped".
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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*
Email ID
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