Adult Separation Anxiety Questionnaire (ASA-27). Rate how often you have experienced each situation in recent months.
1.I worry that something bad will happen to the people I love.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
2.I find it hard to separate from close people, even for short periods.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
3.I need to know where significant people are at all times.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
4.I am afraid of being alone.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
5.I have nightmares about separation or losing loved ones.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
6.I feel physical anxiety (palpitations, nausea) at separations.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
7.I avoid traveling alone or spending nights away from home.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
8.I repeatedly call or text significant people when I am away.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
9.I find it hard to sleep if my partner or a family member isn't nearby.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
10.I think I couldn't cope without the people I love.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
11.I get distressed when loved ones are late.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
12.I check several times that my loved ones are okay.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
13.I feel more emotionally dependent than I would like.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
14.When I separate from someone important, it takes me a while to calm down.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
15.I fear losing loved ones to illness or accident.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
16.I struggle to concentrate when away from loved ones.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
17.I avoid relationships that involve long separations.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
18.I have physical symptoms when thinking about future separations.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
19.I feel uncomfortable sleeping in unfamiliar places.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
20.I need objects that remind me of loved ones to feel safe.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
21.I feel sad or empty when I am alone.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
22.I suffer in advance before foreseeable goodbyes.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
23.My relationships are affected by my need for closeness.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
24.I fear that my partner or family will abandon me.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
25.I have made important decisions to avoid separations.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
26.I feel excessively relieved when a loved one returns.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
27.Separation anxiety interferes with my work or social life.
- [0]Never / Doesn't apply
- [1]Sometimes
- [2]Often
- [3]Very often / Almost always
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