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Attachment Styles and How They Affect Development.
This is a survey about attachment styles and how they can affect a person’s development.
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Personal questions
A few questions about your life
1. ) On a scale, rate your self esteem level?
*
Very low
1
2
3
4
5
Very high
2. ) Do you feel like you have a fear of rejection?
Definitely
1
2
3
4
5
Not at all
Clear selection
3. ) On a scale, rate your ability to manage your stress.
*
Very low
1
2
3
4
5
Very high
4. ) Do you feel confident in regulating your emotions?
Definitely
1
2
3
4
5
Not at all
Clear selection
5. ) Do you find it easy to connect with others?
Definitely
1
2
3
4
5
Not at all
Clear selection
Parental guidance
A few questions on your parent(s) or parental figure(s)
6. ) As a child, did you feel your parent(s) acknowledged your feelings?
*
Definitely
1
2
3
4
5
Not at all
7. ) Growing up in your home, did you feel like you were seen and valued?
Definitely
1
2
3
4
5
Not at all
Clear selection
8. ) On a scale, rate how intimidated you are by your parent(s)?
*
Not at all
1
2
3
4
5
Very much so
9. ) As a child, did you feel your parents met your needs most of the time?
Definitely
1
2
3
4
5
Not at all
Clear selection
10. ) Do you feel like you can handle difficult problems by yourself?
Definitely
1
2
3
4
5
Not at all
Clear selection
11. ) Do you have a positive view of your childhood?
Definitely
1
2
3
4
5
Not at all
Clear selection
12. ) Do you view your parent(s) as a safe space?
Definitely
1
2
3
4
5
Not at all
Clear selection
Relationship
A few questions about your social relationships
13. ) Do you feel like you are more or less likely to fall in love easily?
More likely
1
2
3
4
5
Less likely
Clear selection
14. ) Do you feel you are good at communication when it comes to relationships?
Definitely
1
2
3
4
5
Not at all
Clear selection
15. ) How comfortable do you feel depending on others?
Definitely
1
2
3
4
5
Not at all
Clear selection
16. ) On a scale, rate how emotionally available you feel.
*
Not at all
1
2
3
4
5
Very much so
17. ) Do you feel you are able to be interdependent?
Definitely
1
2
3
4
5
Not at all
Clear selection
18. ) Do you feel you have a fear of abandonment?
Definitely
1
2
3
4
5
Not at all
Clear selection
19. ) Do you feel you have difficulty trusting others?
Definitely
1
2
3
4
5
Not at all
Clear selection
20. ) How comfortable do you feel about being independent?
*
Definitely
1
2
3
4
5
Not at all
Demographics
A few questions about you
21. ) How old are you?
*
Choose
Below 18
18-24
25-30
31-40
41-50
Above 50
22. ) What gender do you identify as?
*
Male
Female
Prefer not to say
Other:
23. ) Please specify your ethnicity.
*
African-American
Latino or Hispanic
Asian
Caucasian
Native American
Native Hawaiian or Pacific Islander
Other:
24. ) Are you in a relationship?
*
Yes
No
25. ) Do you have children?
*
Yes
No
Submit
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