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What kind of psychological abuse have you experienced in
this relationship? Check off all that apply during this particular
relationship. Use the following codes:
1 = has not occurred
2 = threatened
3= once
4 = two to four times
5 = five or more times, frequently
Psychological Torture: Isolation
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Locked in a house, room or
closet |
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 |
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_____ |
Tied up with rope, chains, handcuffs,
etc. |
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_____ |
Forced to live in isolated settings
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_____ |
Frequent moves |
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_____ |
Controlled socialization with family or
friends |
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_____ |
Monitored use of telephone/mail |
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| Psychological Torture:
Degradation |
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_____ |
To curse, name-call such as stupid,
worthless, etc. |
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_____ |
To depreciate |
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_____ |
Public humiliation |
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_____ |
Private humiliation |
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_____ |
Denial of power or competency |
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_____ |
Forced prostitution or sex acts with
others |
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_____ |
Forced pornography |
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_____ |
Rejection (emotional, intellectual,
social, sexual, affectional) |
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How To Get Help
Call Missouri Shores Domestic Violence Center at 1-800-696-7187 or the
national domestic violence hot line at 1-800-333-SAFE right
now to find a local battered woman shelter.
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