Randi Fredricks, Codependency Questionnaire

Codependency Questionnaire

This Codependency Questionnaire is not intended to be a diagnostic tool but instead is meant to give you and I a better idea what is happening to you in terms of codependency.

Answer the questions below to the best of your ability.

Rate your answers as follows:

(1) Agree
(2) Disagree
(3) I don't know

1. I tend to overextend myself when taking care of others.

1	2	3

2. I have a hard time receiving and accepting things from others.

1	2	3

3. Fear of someone else's anger has a lot of influence over what I say or do.

1	2	3

4. I shouldn't do anything to make others angry at me.

1	2	3

5. It builds myself-esteem when I help others solve their problems.

1	2	3

6. It is usually my fault when someone I care about is upset with me.

1	2	3

7. I avoid confrontation at all costs.

1	2	3

8. I often feel humiliated by even the slightest criticism.

1	2	3

9. When someone I care about is uncommunicative, I assume that I have done something wrong.

1	2	3

10. I feel anxiety when other people have problems that I can't solve.

1	2	3

11. If a friend or family member has a problem, I feel like it is my job to fix it.

1	2	3

12. I think I am a perfectionist.

1	2	3

13. I find it difficult to be playful around other adults.

1	2	3

14. At the end of the day, I review my interactions with others and anguish about my choice of words.

1	2	3

15. If my partner is having a bad day, I feel guilty if I am in a good mood.

1	2	3

16. I expect my partner to recognize and accommodate my emotional needs even though I am unable to articulate them.

1	2	3

17. I am deeply distressed by expressions of anger even if they're not directed at me.

1	2	3

18. I feel embarrassed if my partner catches mw doing something frivolous, like reading a magazine.

1	2	3

19. I sometimes have anxiety over small imperfections in my appearance, home, or work.

1	2	3

20. If someone important to me expects me to do something, I should do it.

1	2	3

Congratulations on completing this questionnaire. Enter your contact information below and I will contact you within the next day to discuss your results and find out if you would like to schedule an appointment.

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Telephone:
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Dr. Randi Fredricks Ph.D. is a Psychotherapist and licensed as a Marriage Family Therapist MFC 47803. Dr. Fredricks is not licensed with the California Medical
Board or the California Bureau of Naturopathic Medicine. © 2012 Randi Fredricks, Marriage and Family Therapist, Inc. All rights reserved. Serving
San Jose, Sunnyvale, Santa Cruz, Palo Alto, Monte Sereno, Los Gatos, Cupertino, Mountain View, Scotts Valley, Campbell, Willow Glen, and Milpitas CA.