Heartbreak-Induced Depression Questionnaire

When you’ve just gone through a heart-achingbreakup, grief doesn’t always wait until you’re alone.
You can start crying out of nowhere—at work, in the middle of running errands,while you’re trying to “act normal.”

And sometimes it doesn’t even come out as tears.
Sometimes it looks like this:

You sleep for 8, 9, even 10 hours… and stillwake up exhausted, or sleep has become hard work and you have permanent darkcircles under your eyes.
Getting out of bed feels like dragging your whole body through wet cement.
You’re not lazy. You’re not “weak.” Your system is worn out.

The Heartbreak-Induced Depression Questionnairewas created for that exact experience. It’s a gentle, structuredself-assessment designed to help you understand what your breakup has actuallydone to you emotionally, mentally, and physically—especially when your energy,motivation, and sense of self feels as if they’ve collapsed.

Created through the Anagenesis Method™,this questionnaire helps you name what’s happening underneath the fatigue, suchas:

●      Emotional depletion andshutdown

●      Attachment trauma patterns (the kind that leave you feeling unsafe, restless, or numb)

●      Nervous system dysregulation (why your body won’t “reset,” even after sleep)

●      Loss of self-worth after rejection or abandonment

Instead of spiraling into “What’s wrong withme?” this gives you something steadier: clarity.
You’ll come away understanding whatsymptoms are showing up—and what needs support first: your sleep, your mood,your nervous system, your self-worth, or your sense of purpose.

This isn’t a diagnosis. It’s a starting point—away to feel less lost, less ashamed, and more guided. A small but powerfulfirst step toward getting your footing back.

Important note: This questionnaire is not a diagnostic tool. Ifsymptoms persist for 2 weeks or more, or if you’re having thoughts ofself-harm, please seek support from a qualified mental health professional orurgent services immediately.