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Broken Heart Assessment
A break-up is the death of a relationship and the grief can be more intense than the loss of a loved one to physical death due to the fact that the person is still alive and has taken access to their life away from you. Acceptance can be almost impossible without support.
This assessment will give you insight on how you are dealing with the loss of a relationship and if you need assistance healing.
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Are You Dying of a Broken Heart?
Are you finding it extremely hard or even impossible to move on with your life?
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Yes
No
Are you having random and/or frequent episodes of crying?
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Yes
No
Are you waiting on an explanation for closure?
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Yes
No
Are you triggered by the thought of the person in a negative way?
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Yes
No
Does it hurt to see that they have moved on with their life?
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Yes
No
Do you fantasize about them coming back like a knight in shining armor?
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Yes
No
Are you making up stories and scenarios about the person in your head?
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Yes
No
Do you hope something bad happens to the person? (Karma)
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Yes
No
Do you rehearse what you will say or do the next time you encounter this person?
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Yes
No
Are you watching them on social media?
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Yes
No
Has your appetite changed drastically? (Not eating or emotional eating)
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Yes
No
Has your sleep pattern changed? (You have insomnia or you're sleeping too much)
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Yes
No
Are your bones and joints aching? (Unexplained body aches)
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Yes
No
Have you lost interest in the things you once loved?
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Yes
No
Are you isolating yourself from friends and family? (No interest in social activities)
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Yes
No
Are you struggling to stay focused? (Work, task, household chores, etc.)
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Yes
No
Are you having anxiety attacks? (Feels like you can't breathe, rapid heart rate, intrusive thoughts)
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Yes
No
Do you feel depressed?
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Yes
No
Are you pretending that you are okay, but fall apart when you are alone? (Life of the party in public)
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Yes
No
Are you having difficulty getting the person out of your head?
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Yes
No
Is this person all you talk about? (Your friends and family don’t want to hear it anymore)
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Yes
No
IF YOU ANSWERED YES TO 3 OR MORE OF THESE QUESTIONS LET'S CONNECT
https://calendly.com/coachtray/one-on-one-coaching
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