What is your age range?
18-24
25-34
35-44
45-54
55+
How far does your ex live?
Same city/town as you
In a nearby city or town (less than 1 hour commute)
In another state or province (over 2 hour commute)
In another country
I don't know
How long were you in a relationship with your ex?
Less than 6 months
6 months to 1 year
1 to 2 years
3 to 5 years
5+ years
What was the nature of your relationship?
Casual/short term
Committed, discussions of a future
On and off
Very serious, plans for a future together
How would you describe the overall quality of the relationship before the breakup?
Very healthy and supportive
Mostly good, with occasional issues
Struggling with many unresolved issues, but effort on both sides
Very unhealthy and toxic
Did you and your ex argue often?
Rarely (less than once per month)
Occasionally (maybe once per month)
Often (every week at least)
Frequently (basically everyday)
Did you experience clinginess or neediness in the relationship? If so, who displayed this?
My ex
Me
Neither
Both
Did you experience jealousy in the relationship? If so, who displayed this?
Me
My ex
Neither
Both
Did you experience emotional distance in the relationship? If so, who displayed this?
Me
My ex
Neither
Both
Did you experience lifestyle incompatibility in the relationship?
Yes, and I did not compromise
Yes, and my ex did not compromise
No lifestyle incompatibility
Yes, but we both compromised
One person did nothing wrong, but the other left unexpectedly:
I left unexpectedly
My ex left unexpectedly
This was a build up and I expected the breakup
How would you describe your attachment style during this relationship?
Secure
Anxious (clingy/needy tendencies)
Avoidant (pulled away, did not communicate well)
Disorganized (a bit of both)
Not sure
Did you feel like your ex was emotionally distant?
Yes, frequently
Occasionally
Not often
After the breakup, did you attempt to get your ex back? If so, when?
Yes, immediately
After a few weeks, yes
After several months
No, I have not contacted my ex since the breakup
If you did try to get them back, how long were begging or pleading for them back?
A few days
A few weeks
A few months
I did not beg
On a scale of 1-10, how much did you engage in desperate behavior?
1-4
5-7
8-10
When was the last time you had a conversation with your ex?
A few days ago
A few weeks ago
A few months ago
More than 6 months ago
What was the tone of the last conversation with your ex?
Friendly and civil (polite but nothing more)
Emotional (crying, or expressing emotions of sadness)
Tense but civil (slight anger)
Avoidant or cold (annoyed)
Flirtatious, upbeat or generally positive
What did your ex say during the last conversation?
Expressed that they missed me
Gave closure, or said its over for good
Said they weren't ready to talk
Didn't say much, seemed distant
What did you say during the last conversation?
I expressed my feelings and asked for another chance
I tried to stay calm, and be understanding
I apologized for past mistakes, but begged
I apologized for past mistakes, but did not beg
I didn't say much, just agreed with what was said
What was your ex's main reason for the breakup?
They needed space (personal issues)
They fell out of love
They felt unappreciated
We had too many fights
Infidelity
I don't know, or unclear reasons
They needed space (specifically because of you)
How did/does your ex seem after the breakup?
Sad but relieved, firm in their decision
Conflicted, mixed signals
Completely cold, nothing at all
Overly happy, flaunting new single life
They want to stay friends
Has your ex contacted you after the breakup?
Once (only about belongings)
Once, about anything (except belongings)
Yes, a few times
No, they have not reached out