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Gaslighting Self-Assessment Form

Please answer the following questions honestly based on your experiences.

Name (Optional): Age: How long have you been in your current relationship?

Assessment Questions

For each statement, select the response that best matches your experience.
1 (Never) - 2 (Rarely) - 3 (Sometimes) - 4 (Often) - 5 (Always).

1. My partner frequently questions my memory of events, insisting they happened differently than I recall.
1 2 3 4 5

2. I feel like I constantly second-guess myself when we have disagreements.
1 2 3 4 5

3. My partner accuses me of being overly sensitive or irrational during arguments.
1 2 3 4 5

4. I often feel the need to apologize, even when I don't believe I've done anything wrong.
1 2 3 4 5

5. My partner dismisses my feelings or tells me they’re not valid.
1 2 3 4 5

6. I’ve started doubting my own perceptions of reality because of things my partner says.
1 2 3 4 5

7. When I express concerns, my partner shifts the blame or makes me feel guilty.
1 2 3 4 5

8. My partner has told me things like 'You’re crazy' or 'You’re imagining things.'
1 2 3 4 5

9. I feel isolated or unsupported because of how my partner interacts with me.
1 2 3 4 5

10. I feel like I have to 'walk on eggshells' to avoid upsetting my partner.
1 2 3 4 5