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Do you have an ever-present sense of inadequacy as a man?

Yes            No

Do you believe you are ineffectual in your role as a husband or as a romantic partner?

Yes            No

Do you believe you are ineffectual in your role as a father?

Yes            No

Do you believe you are inadequate as a provider for your family?

Yes            No

Do you have persistent problems in your relationships at home, at work, or with friends?

Yes            No

Are you unable to make decisions that benefit others or even yourself?

Yes            No

Is procrastination, rather than being a means to a creative end, a real problem at home, work, and in social situations?

Yes            No

Are you incapable of imagining fulfilling your life’s purpose?

Yes            No

Do you feel like a failure on a daily basis?

Yes            No

Do you experience rage and frequent outbursts of anger?

Yes            No

Do you express aggression toward women or children?

Yes            No

Do you bully people?

Yes            No

Do you engage in daredevil behavior, taking unnecessary risks?

Yes            No

Are you promiscuous?

Yes            No

Are you chauvinistic or patronizing in your behavior or attitude toward women, children, or men you believe to be inferior to you?

Yes            No

Are you unable to have a friendship with a man or woman because you cannot refrain from being competitive?

Yes            No

Does your wife or romantic partner “mother” you?

Yes            No

Does your wife or romantic partner chronically second-guess your decisions and choices?

Yes            No

Does your wife or romantic partner feel free to correct you in public in ways that are embarrassing?

Yes            No

Does your wife or romantic partner frequently pick lint off your clothes or in other ways “clean you off”?

Yes            No

Does your wife or romantic partner monitor your conversations?

Yes            No

Does your wife or romantic partner frequently take care of things on your behalf that you could do yourself?

Yes            No

Do you feel driven to submission on a regular basis by your wife or romantic partner?

Yes            No

Does your wife or romantic partner always try to put your needs and desires first?

Yes            No

Is your wife or romantic partner your “sex slave”?

Yes            No

Do you treat your wife or romantic partner like a servant?

Yes            No

Does your wife or romantic partner have affairs?

Yes            No

Does your mother ask you to do things for her that she should ask her husband to do for her and that he is capable of doing (such as chores around the house or getting the car serviced, etc.)?

Yes            No

Does your mother come to you, rather than to her husband, for solace, encouragement, comfort, or support?

Yes            No