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? *
Are you having random and/or frequent episodes of crying? *
Are you waiting on an explanation for closure? *
Are you triggered by the thought of the person in a negative way? *
Does it hurt to see that they have moved on with their life? *
Do you fantasize about them coming back like a knight in shining armor? *
Are you making up stories and scenarios about the person in your head? *
Do you hope something bad happens to the person? (Karma) *
 Do you rehearse what you will say or do the next time you encounter this person? *
 Are you watching them on social media? *
Has your appetite changed drastically? (Not eating or emotional eating) *
Has your sleep pattern changed? (You have insomnia or you're sleeping too much) *
Are your bones and joints aching? (Unexplained body aches) *
Have you lost interest in the things you once loved? *
Are you isolating yourself from friends and family? (No interest in social activities) *
Are you struggling to stay focused? (Work, task, household chores, etc.) *
Are you having anxiety attacks? (Feels like you can't breathe, rapid heart rate, intrusive thoughts)   *
Do you feel depressed? *
Are you pretending that you are okay, but fall apart when you are alone? (Life of the party in public) *
Are you having difficulty getting the person out of your head? *
Is this person all you talk about? (Your friends and family don’t want to hear it anymore) *
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This form was created inside of Tray Kearney. Report Abuse