Am I Heartbroken Quiz
Questions: 15 · 10 minutes
1. When routine responsibilities such as hygiene, medication, bills, childcare, or household tasks arise, how are you managing?
I am managing my essential responsibilities normally.
Some tasks take extra effort, but essential needs are still covered.
Several important tasks are being postponed or missed.
Essential needs are going unmet, creating an immediate health, care, or safety concern.
2. You need to complete a familiar task at work, school, or home. What is most likely right now?
I can focus and complete it about as usual.
My mind wanders to the loss, but I can redirect myself.
Repeated thoughts or fatigue cause delays, mistakes, or unfinished work.
I cannot manage essential tasks or make decisions needed for my immediate wellbeing.
3. How have alcohol, drugs, reckless driving, dangerous dares, or other high-risk actions featured in your coping?
They have not been part of how I cope with this loss.
I have felt an urge toward risky coping but chosen a safer alternative.
I have used substances or taken risks more than once to escape the feelings.
My coping has caused or could imminently cause overdose, injury, impaired driving, or another immediate danger.
4. On nights when thoughts about the loss appear, what best describes your sleep?
My sleep remains close to its usual pattern.
I sometimes take longer to settle or wake earlier than usual.
My sleep is repeatedly shortened, broken, or unusually prolonged.
I am barely sleeping, cannot get out of bed, or feel unable to function safely from exhaustion.
5. A friend invites you to a low-pressure activity you would usually consider. How do you tend to respond?
I decide based on interest and energy rather than avoiding everyone.
I hesitate or decline occasionally but remain in contact.
I repeatedly withdraw even when part of me wants connection.
I have cut myself off almost completely and feel unable to reach anyone despite intense distress.
6. If you needed help tonight, what best describes your access to support?
I can identify someone or a service and would contact them.
Support exists, although embarrassment or hesitation may slow me down.
I struggle to identify or reach someone who could stay with me or help.
I feel completely cut off, am being prevented from seeking help, or have no way to stay safe alone.
7. Over the past two weeks, how present has sadness about the relationship loss been?
I have not felt notable sadness about it.
Sadness has appeared in brief, manageable moments.
Sadness has occupied large parts of several days.
Sadness has felt nearly constant or emotionally unbearable.
8. After replaying what happened, where do your thoughts about yourself tend to land?
I can consider my part without attacking my worth.
I occasionally question myself but can regain perspective.
I repeatedly criticize myself or feel fundamentally rejected.
I feel worthless or entirely to blame, and the thoughts are hard to interrupt.
9. When you imagine life beyond this loss, which response is closest?
I can picture meaningful possibilities, even if they are different now.
The future feels uncertain, but I can still see some possibilities.
It is difficult to imagine feeling connected or hopeful again.
The future feels pointless or as though nothing meaningful remains.
10. When a message, place, song, or other reminder catches you unexpectedly, what usually happens?
I notice it without a meaningful emotional reaction.
I feel a short wave of emotion and then regain my footing.
The reaction disrupts my mood or attention for hours.
The reaction overwhelms me or feels impossible to settle without help.
11. How has the loss affected your ability to enjoy activities that normally matter to you?
I can still enjoy them about as usual.
My interest is somewhat reduced, but enjoyment still breaks through.
I often struggle to feel interested or pleased.
Almost nothing feels enjoyable, and I feel emotionally shut down.
12. Have you had thoughts of hurting yourself or not wanting to be alive?
No, I have not had those thoughts.
I have had fleeting, unwanted thoughts without wanting to act on them.
The thoughts recur or are hard to dismiss, though I do not have immediate intent.
I have current intent, a plan, recent self-harm, or doubt that I can keep myself safe.
13. When the emotional pain spikes, how confident are you that you can avoid harming yourself?
I feel able to stay safe and know what I would do if that changed.
Staying safe takes effort, but I can use a coping step or contact someone.
I am sometimes unsure and need another person to help me stay safe.
I am currently unsure or unable to keep myself safe.
14. Has the breakup or relationship conflict involved unwanted contact, monitoring, threats, force, or fear for your safety?
No, I have not experienced those behaviours.
There has been unwanted contact or boundary-pushing that has made me uncomfortable.
There has been repeated monitoring, intimidation, or threatening behaviour that makes me fear escalation.
There has been physical or sexual force, stalking, injury, a credible threat, or immediate fear for my safety—even once.
15. How has eating changed since the relationship loss?
My appetite and eating pattern are essentially unchanged.
I occasionally eat more or less when emotions rise.
I regularly skip meals, overeat, or struggle to maintain my usual intake.
I am going prolonged periods without adequate food or fluids, or eating in a way that feels physically dangerous.