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The following questionnaire is for personal information only and is not meant to be a professional evaluation. As with many research questionnaires, this questionnaire may not be normed for online participants. Please take this into account when you receive the results. However, as more people complete these questionnaires the results will become more accurate. You may be asked after you complete the questionnaire to submit it for research purposes which will improve the accuracy of results.

This questionnaire determines how sensitive you are to rejection.

The items below describe situations in which people sometimes ask things of others. For each item, imagine that you are in the situation, and then answer the questions that follow it.

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Situation 1: You ask your parents or another family member for a loan to help you through a difficult financial time.

How concerned or anxious would you be over whether or not your family would want to help you?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that they would agree to help as much as they can.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 2:  You approach a close friend to talk after doing or saying something that seriously upset him/her.

How concerned or anxious would you be over whether or not your friend would want to talk with you?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that he/she would want to talk with me to try to work things out.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 3: You bring up the issue of sexual protection with your significant other and tell him/her how important you think it is.

How concerned or anxious would you be over his/her reaction?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that he/she would be willing to discuss our possible options without getting defensive.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 4: You ask your supervisor for help with a problem you have been having at work.

How concerned or anxious would you be over whether or not the person would want to help you?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that he/she would want to try to help me out.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 5: After a bitter argument, you call or approach your significant other because you want to make up.

How concerned or anxious would you be over whether or not your very significant other would want to make up with you?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that he/she would be at least as eager to make up as I would be.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 6: You ask your parents or other family members to come to an occasion important to you.

How concerned or anxious would you be over whether or not they would want to come?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that they would want to come.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 7: At a party, you notice someone on the other side of the room that you'd like to get to know, and you approach him or her to try to start a conversation.

How concerned or anxious would you be over whether or not the person
would want to talk with you?
 

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that he/she would want to talk with me.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 8: Lately you've been noticing some distance between yourself and your significant other, and you ask him/her if there is something wrong.

How concerned or anxious would you be over whether or not he/she still
loves you and wants to be with you?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that he/she will show sincere love and commitment to our relationship no matter what else may be going on.

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

Situation 9: You call a friend when there is something on your mind that you feel you really need to talk about.

How concerned or anxious would you be over whether or not your friend
would want to listen?

Very Unconcerned___________________________Very Concerned

  1          2          3          4          5         6

I would expect that he/she would listen and support me.
 

Very Unlikely____________________________________Very Likely

  1         2          3          4          5         6

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