LAGOS STATE UNIVERSITY

FACULTY OF SOCIAL SCIENCES

DEPARTMENT OF PSYCHOLOGY
Dear respondents,
I am an undergraduate of the above department and this is a part of my BSC research work. Please
read through the statements in each section carefully and respond to them as accurately and
truthfully as possible to ensure true results of the study. This questionnaire is designed to obtain
information which would be used purely for academic purposes. Your response will be treated
with utmost confidentiality.
Thank you.
SECTION A
Instruction: please tick [✔] the option that correctly applies to you from the alternatives below.
Sex: Male [ ] Female [ ]
Age: __________________
Religion: Christianity [ ] Islam [ ] Others [ ]
Have you ever been in a relationship? Yes [ ]No [ ]
Are you currently in a relationship? Yes [ ] No [ ]
SECTION B
Instruction: Please answer each question as carefully and accurately as possible as they apply to
you. You are to tick one of the options [0-never, 1-sometimes, 2- often, 3-usually, 4- all of the
time]
S/N ITEMS 0 1 2 3 4
1 “Test” your love, setting traps to find out if you are cheating.
2 You feel compelled to have sex as long as you don’t have to explain why.
3 Has beaten you.
4 Is a good student, but is always at meetings, does not fulfil his/her
promises, and is irresponsible.
5 Talks to you about relationships he/she imagines you have.
6 Insists on touching you in ways and places which you don’t like and don’t
want.
7 Has slapped your face, pushed, or shaken you.
8 Does not acknowledge any responsibility regarding the relationship or
what happens to both of you.
9 Criticizes you, underestimates the way you are or humiliates your self-
esteem.
10 Has thrown blunt instruments at you.
11 Has hurt you with an object.
12 Ridicules your way of expressing yourself.
13 Has physically kept you from leaving.
14 You feel forced to perform certain sexual acts.
15 Has ignored your feeling.
16 Stops talking to you or disappear for several days, without any
explanation, to show their annoyance.
17 Invades your space (listening to a loud music when studying, listening to
your phone calls……….).
18 Forces you to undress even if you don’t want to.
19 Has ridiculed or insulted your beliefs, religion, or social class.
20 Ridicules or insults you for the ideas you uphold.
 SECTION C
Instructions: Please read each of the following statements carefully and respond as accurately as
they apply to you. You are to tick one of the options. [1 –Completely untrue of me, 2- Mostly
untrue of me, 3- Slightly more true than untrue, 4- Moderately true of me, 5- Mostly true of
me, 6- Describes me perfectly]
S/n ITEMS 1 2 3 4 5 6
1 I worry that the people I love will die soon, even
though there is little medical reason to support my
concern
2 I find myself clinging to people I’m close to because
I’m afraid they’ll leave me.
3 I worry that people I feel close to will leave me or
abandon me.
4 I feel that I lack a stable base of emotional support.
5 I don’t feel that important relationships will last; I
expect them to end.
6 I feel addicted to partners who can’t be there for me in
a committed way.
7 In the end, I will be alone.
8 When I feel someone I care for pulling away from me,
I get desperate.
9 Sometimes I am so worried about people leaving me
that I drive them away.
10 I become upset when someone leaves me alone, even
for a short period of time.
11 I can’t count on people who support me to be there on
a regular basis.
12 I can’t let myself get really close to other people,
because I can’t be sure they’ll always be there.
13 It seems that the important people in my life are
always coming and going.
14 I worry a lot that the people I love will find someone
else they prefer and leave me.
15 The people close to me have been very unpredictable:
one moment they’re available and nice to me; the next,
they’re angry, upset, self -absorbed, fighting, etc.
16 I need other people so much that I worry about losing
them.
17 I can’t be myself or express what I really feel, or
people will leave me.

SECTION D
Instructions: Please read each of the following statements carefully and respond as they apply
to you. You are to tick one of the following options [1=strongly agree, 2=agree, 3=disagree,
4=strongly disagree]
S/N ITEMS 1 2 3 4
1 On the whole, I am satisfied with myself.
2 At times I think I am no good at all.
3 I feel that I have a number of good qualities.
4 I am able to do things as well as most other people.
5 I feel I do not have much to be proud of.
6 I certainly feel useless at times.
7 I feel that I’m a person of worth.
8 I wish I could have more respect for myself.
9 All in all, I am inclined to think that I am a failure.
10 I take a positive attitude toward myself.

SECTION E
Instructions: Please answer each question carefully and respond as accurately as possible as
they apply to you. You tick one of the options. [1=absolutely false, 2=false, 3=neither false
nor true, 4=true, 5=absolutely true].
S/N ITEMS 1 2 3 4 5
1 I drink to be more talkative.
2 Drinking alcohol helps me overcome my shyness.
3 I drink to ease relations with the opposite sex.
4 I drink to feel more self-confident.
5 Drinking helps me feel at ease within my group.
6 I drink when I am sad.
7 I drink alcohol to deal with feeling of despair.
8 I sometimes drink when I am angry.
9 I drink alcohol to escape from everyday problems.
10 I drink when I need to relax.
11 Never turn down a free drink.
12 When alcohol is free it’s stupid not to take advantage.
13 When offered several free drinks in one evening I drink more
than usual.
14 When I am offered a free drink I accept even if I don’t it.
15 I consume less when I have to pay for every drink I have.