Narcissistic abuse questionnaire

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1. Whats your age?

under 18
18-24
25-34
35-54
55+

2. Sex

Male
Female
Other

3. How did you meet your partner?

4. Sexual orientation?

Heterosexual
Lesbian
Gay
Bi
LGBT
Other

5. How long were you with your partner?

6. Were you married?

Yes
No

7. Did/do you have children together?

Yes
No

8. Are you still with them?

Yes
No

9. What personality traits would you say your narcissist has/d?

Lies
Manipulation
delusions of grandeur
Showed signs of anxiety
Aggressive
Needed to be admired by others
Hypersensitive
Delusions of persecution
Sense of entitlement
Neurotic
Changes any subject to be about themselves
Secret life
Makes you question yourself
Makes/made you feel guilty for everything
Made you continuously feel like you had to walk on egg shells because of their feelings
Every others had done they had done bigger or better
Smugness
Lack of empathy
Self absorption
Passive aggressive
Played the 'Misunderstood person'
Emotionally unavailable unless their is something in it for them
Creates chaos where there isn't any
Is never wrong
Tries to control
Shifts blame
Low morals but expects yours to be high

10. How would you say your health was on a scale of 1-10 (1 being positive and 10 negative)?

Before your narcissistic relationship (if the relationship was with a parental figure or whole life then ignore this question)

1
2
3
4
5
6
7
8
9
10

11. During your narcissistic relationship

1
2
3
4
5
6
7
8
9
10

12. Immediately after your narcissistic relationship

1
2
3
4
5
6
7
8
9
10

13. A year after

1
2
3
4
5
6
7
8
9
10

14. Several years later

1
2
3
4
5
6
7
8
9
10

15. Please list any mental or physical health issues you feel you suffered with in regards to the relationship.

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