1

Do you keep secrets about your sexual behavior or romantic fantasies from those important to you? Do you lead a double life?

Yes
No
2

Have your desires driven you to have sex in places or with people you would not normally choose?

Yes
No
3

Do you need greater variety, increased frequency, or more extreme sexual activities to achieve the same level of excitement or relief?

Yes
No
4

Does your use of pornography occupy large amounts of time and/or jeopardize your significant relationships or employment?

Yes
No
5

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
6

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
7

Have your sexual practices caused you legal problems? Could your sexual practices cause you legal problems?

Yes
No
8

Does your pursuit of sex or sexual fantasy conflict with your moral standards or interfere with your personal spiritual journey?

Yes
No
9

Do your sexual activities involve coercion, violence, or the threat of disease?

Yes
No
10

Has your sexual behavior or pursuit of sexual relationships ever left you feeling hopeless, alienated from others, or suicidal?

Yes
No
11

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
12

Do you compulsively avoid sexual activity due to fear of sex or intimacy? Does your sexual avoidance consume you mentally?

Yes
No