| 1. |
Have you ever
lost time from work or school
due to shoplifting? |
Y/N |
| 2. |
Has shoplifting ever created
problems in your relationships? |
Y/N |
| 3. |
Has shoplifting ever affected
your reputation or people’s
opinion of you? |
Y/N |
| 4. |
Have you ever felt guilt,
shame, or remorse after shoplifting? |
Y/N |
| 5. |
Did you ever shoplift
to get money to pay debts or
to solve money issues? |
Y/N |
| 6. |
Did shoplifting ever cause
a decrease in your ambition
or efficiency? |
Y/N |
| 7. |
Did you ever experience
a “high” or “rush”
of excitement when you shoplifted? |
Y/N |
| 8. |
Have you ever shoplifted
to escape worries or troubles? |
Y/N |
| 9. |
Has shoplifting caused
you to have difficulty eating
or sleeping? |
Y/N |
| 10. |
Do arguments, disappointments
or frustrations create an urge
to shoplift? |
Y/N |
| 11. |
Have you noticed you
began shoplifting more frequently
over time? |
Y/N |
| 12. |
Have you ever considered
self-destruction or suicide
as a result of your shoplifting? |
Y/N |
| 13. |
Upon stopping shoplifting,
did you continue to be tempted/preoccupied
by it? |
Y/N |
| 14. |
Have you kept your shoplifting
a secret from most of those
you are close to? |
Y/N |
| 15. |
Have you told yourself
“this is my last time”
and still shoplifted again? |
Y/N |
| 16. |
Have you continued to
shoplift despite having been
confronted or arrested? |
Y/N |
| 17. |
Do you often feel angry
or feel a need for control? |
Y/N |
| 18. |
Do you have persistent
feelings of life being unfair? |
Y/N |
| 19. |
Do you have persistent
feelings of entitlement to get
“something for nothing? |
Y/N |
| 20. |
Do you have trouble speaking
up for yourself, asking for
help, or saying “no"? |
Y/N |