¹
Yes
No
1
Were you sexually abused as a child or adolescent?
2
Did your parents have trouble with sexual behavior?
3
Do you often find yourself preoccupied with sexual thoughts?
4
Do you feel that your sexual behavior is not normal?
5
Do you ever feel bad about your sexual behavior?
6
Has your sexual behavior ever created problems for you and your family?
7
Have you ever sought help for sexual behavior you did not like?
8
Has anyone been hurt emotionally because of your sexual behavior?
9
Are any of your sexual activities against the law?
10
Have you made efforts to quit a type of sexual activity and failed?
11
Do you hide some of your sexual behaviors from others?
12
Have you attempted to stop some parts of your sexual activity?
13
Have you felt degraded by your sexual behaviors?
14
When you have sex, do you feel depressed afterwards?
15
Do you feel controlled by your sexual desire?
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?
17
Do you ever think your sexual desire is stronger than you are?
18
Is sex almost all you think about?
19
Has sex (or romantic fantasies) been a way for you to escape your problems?
20
Has sex become the most important thing in your life?
21
Are you in crisis over sexual matters?
22
The Internet has created sexual problems for me.
23
I spend too much time online for sexual purposes.
24
I have purchased services online for erotic purposes (sites for dating, pornography, fantasy and friend finder).
25
I have used the Internet to make romantic or erotic connections with people online.
26
People in my life have been upset about my sexual activities online.
27
I have attempted to stop my online sexual behaviors.
28
I have subscribed to or regularly purchased or rented sexually explicit materials (magazines, videos, books or online pornography).
29
I have been sexual with minors.
30
I have spent considerable time and money on strip clubs, adult bookstores and movie houses.
31
I have engaged prostitutes and escorts to satisfy my sexual needs.
32
I have spent considerable time surfing pornography online.
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.