Memoirs of the Narcissized
A DEMOGRAPHIC SURVEY
When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.
* Required
1.
How old were you when this relationship started? *
Select your answer
2.
WHAT IS YOUR GENDER *
Woman
Man
3.

WHAT COUNTRY ARE YOU IN? if U.S. put Couintry/State *
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4.
What was your relationship to the other person *
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5.
How long were you in this relationship? *
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6.
Were children involved? *
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7.
Did the abuse involve financial control *
Example: Were you able to have your own money or Were you financially sound at the start but not during or after,
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8.
Did the abuse ever become physical? *
this means hurting you or threatening to hurt you
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9.
Did you ever seek help? *
Police, Doctors, Teachers, Pastors, etc
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10.
If the answer to Question 9 is yes, tell us from whom and whether or not they believed you and/or helped you
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11.
Did any one ever tell you that what you were experiencing was narcissistic abuse? *
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12.
Which of these tactics did the person use on you? *
13.
Gas lighting-telling you that you are crazy
Silent treatment-acting like you are not even there
Ghosting- leaving with no contact
Surveillance/monitoring
Pitting you against others and others against you
Projecting- accusing you of what they are doing
Triangulation-bring in a third person to spark jealousy or insecurity
Blame shifting
Word salad - talking mumbo jumbo to distract you from a point you trying to make
Manipulation-if you this, then I'll that. Threats
Threaten to harm you, your children or pets
Compulsive Lying- lie when there's no reason
Are you still in contact with this person? *
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14.
If it is over, how long has it been? *
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15.
Do you feel you have recovered? *
16.
Yes
No
Maybe
Would you be willing to be contacted for follow up research? *
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