Toxicity Impact Assessment – Carmen Sakurai, Trauma-Informed Life Coach

This comprehensive assessment will help you understand how unhealthy behaviors of those around you affect how you see yourself, interpret your experiences, and how you step into your life.

Answer each question as honestly as you can for the most accurate results. There are 90 "Yes" and "No" questions. Please answer all questions until you are finished.

When you're finished, you will receive your Toxicity Impact Score and its explanation and suggestions for your next steps.

Your information and answers are kept in strict confidence.

Name

Do you feel like you have to walk on eggshells around certain people in your life?

Yes

Have you taken responsibility for someone else’s bad behavior?

Yes

Does anyone in your life deliberately provoke you to feel jealous, angry, sad, etc., then get mad at you for feeling that way?

Yes

Have you accepted the consequences for something you didn't do?

Yes

Are you constantly being negatively compared to others by someone in your life?

Yes

When you react to a hurtful comment, have you been told you’re too sensitive?

Yes

Have your relationships with close friends and family changed for the worse or dissolved altogether?

Yes

Do you avoid talking about your relationship with people who truly care about you?

Yes

Do you find yourself making excuses for the actions and behaviors of others?

Yes

10.

Are you afraid to be alone with anyone in your life?

Yes

11.

Does anyone repetitively call you hurtful/insulting names?

Yes

12.

Is there someone in your life who makes you feel like everything is a competition?

Yes

13.

Do you feel like you are someone’s possession instead of a friend or loved one?

Yes

14.

Have you had a goal that you've let someone talk you out of?

Yes

15.

Is there someone in your life who persistently lies to you?

Yes

16.

Do you ever feel like you're in trouble, like a child who misbehaved?

Yes

17.

Is there someone who tries to interfere with even in the smallest parts of your life?

Yes

18.

Do you feel anxious when you do things others may not approve of?

Yes

19.

Does anyone in your life demand your unearned respect?

Yes

20.

Have you had to set boundaries with someone to keep yourself safe?

Yes

21.

Is there someone in your life who seems to never apologize?

Yes

22.

Is there someone in your life who constantly tells you what’s wrong with you?

Yes

23.

Has something happened in the past to make you fear certain people in your life?

Yes

24.

Do you find yourself trying to be someone you’re not in order to please someone else?

Yes

25.

Have you ever been forced to do/participate in something you didn’t want to?

Yes

26.

Have you ever covered up or lied for someone who treats you badly?

Yes

27.

Is there anyone who makes you feel a knot in your stomach when they're around?

Yes

28.

Is there someone you're afraid to make mad or upset?

Yes

29.

Do you find yourself forced to compete over insignificant issues?

Yes

30.

Do you feel guilty when you do something for yourself?

Yes

31.

Does anyone intentionally embarrass you in front of others?

Yes

32.

Have you tried to remove yourself from a relationship, only to be convinced back with more lies and broken promises?

Yes

33.

Have you ever been absolutely sure about something that was said or done, and have someone try to convince you that you're wrong?

Yes

34.

Have you ever had to fix up a mess made by someone else?

Yes

35.

Have you ever been “given” your opinion?

Yes

36.

Have you ever had to defend doing/buying something nice for yourself to another adult?

Yes

37.

Has anyone blatantly brushed off a rule, guideline, or boundary you've communicated with them?

Yes

38.

Have you ever received an insincere apology from someone you thought you were close to?

Yes

39.

Have you been criticized for things you don't agree with?

Yes

40.

Are you constantly on guard and ready to avoid conflict?

Yes

41.

Are there people in your life who seem to take pleasure in testing you?

Yes

42.

Do you find yourself apologizing for things that aren’t yours to apologize for?

Yes

43.

Are there people in your life that criticize you beyond what you deserve?

Yes

44.

Do you often feel that something bad is about to happen?

Yes

45.

Are you uncomfortable standing up for yourself?

Yes

46.

Do you often suspect you're someone’s consolation prize?

Yes

47.

Does someone in your life take credit for something you’ve accomplished?

Yes

48.

Have you ever felt degraded by someone else’s words?

Yes

49.

Have you felt like stories from someone didn’t add up?

Yes

50.

Is there anyone in your life who makes you feel like all your ideas are bad?

Yes

51.

Have you accepted a lie to keep yourself from going crazy?

Yes

52.

Has someone told your friends and family lies about you?

Yes

53.

Are you in “trouble” so often that you just expect it now?

Yes

54.

Has someone taken even the most insignificant decisions out of your hands?

Yes

55.

Are you reprimanded by anyone if you do something or go somewhere without consulting them?

Yes

56.

Have you been forced to change or eliminate a boundary because it wasn't being respected anyway?

Yes

57.

Have you ever given up on getting an apology?

Yes

58.

Is there someone in your life who hurts you emotionally/physically, then blame you for "making them" do it?

Yes

59.

Have you been forced to isolate yourself from close family & friends in order to save a relationship with someone outside that circle?

Yes

60.

Do you wonder if you really are too sensitive or emotional?

Yes

61.

Have you given up on making your own decisions to avoid conflict?

Yes

62.

Have you wanted to do something, only to have someone else forbid you from doing it?

Yes

63.

Have you been blamed for someone else’s temper or outburst?

Yes

64.

Have you had to re-establish boundaries with someone who has crossed them

Yes

65.

Do you feel like you have to be different people, depending on who you are with?

Yes

66.

Would other people recognize that you are fearful of someone close to you?

Yes

67.

Have you changed who you are to be like someone that someone else likes better?

Yes

68.

Have you felt ridiculed for your lack of ability?

Yes

69.

Have you ever been made to feel guilty for being liked, successful, or admired?

Yes

70.

Have you ever convinced yourself that insults about you may be true?

Yes

71.

Have you felt like you know someone well but are continually surprised with new, unexpected information about them?

Yes

72.

Have you reduced the size of your dream in order to accommodate others’ opinions?

Yes

73.

Have you had to confront the same person more than once about lying to you?

Yes

74.

Do you feel that you’ve lost your support system?

Yes

75.

Are there people in your life that treat you badly but deny doing so?

Yes

76.

Have you ever hidden personal items so they would be safe?

Yes

77.

Do you avoid speaking up or taking action to avoid friction or confrontation?

Yes

78.

Are you bothered by other people's insulting comments?

Yes

79.

Have you stopped doing something you love because someone told you that you had to?

Yes

80.

Have the bad events in another’s life been blamed on you?

Yes

81.

Do you sense jealousy coming from someone in your life?

Yes

82.

Have you heard the same insult so often, that you are numb to it?

Yes

83.

Has there ever been someone in your life you feel doesn’t want you to succeed?

Yes

84.

Have you been deeply hurt by lies told by others?

Yes

85.

Have you had to quit doing something you love in order to avoid conflict?

Yes

86.

Does someone in your life make you feel like you're always falling short? Even when you do just as they asked?

Yes

87.

Do you doubt yourself even when you logically KNOW you're right?

Yes

88.

Do you base your self-worth on what you can do for others?

Yes

89.

Do you believe people won't leave you as long as they need you?

Yes

90.

Do you find yourself saying "Yes" when you really mean "No"?

Yes

1 out of 5

Time's up