How Serious Was Your Abuse?

• Please check the response that best describes your current or past relationship.    

• To learn how serious your abuse has been, total your circled points at the end of the questions and click to go to the next page.

• You may want to print off this form to make it easier to score your points.

* Score the Black questions (1-20): Frequently (3) – Sometimes (2) – Rarely (1) – Never/NA (0)
Score the Red Questions (21-36):  Frequently (6) – Sometimes (5) – Rarely (4) – Never/NA (0)

1.       Does your partner check up on you often and want to know where you are at all times?

 

2.       Is your partner jealous and/or does he/she accuse you of having affairs?

 

3.       Does your partner tell you that you are stupid, lazy, ugly, a rotten cook, a failure as a spouse, bad in bed, etc?

 

4.       Is your partner overly critical of daily things, such as your clothing or your appearance?

 

5.       Does your partner call you obscene names?

 

6.       Does your partner tell you that no one else could ever love you?

 

7.       Does your partner make fun of you in front of other people?

 

8.       Does your partner try to keep you from seeing family and friends?

 

9.       Is your partner ever rude to your friends?

 

10.   Do you ever feel isolated and alone, as if there is nobody close to you to confide in?

 

11.   Does your partner control the family money so that you have to account for every penny and/ or beg them for every item or bit of money?

 

12.   Do you quarrel much over financial matters?

 

13.   Does your partner forbid or demand that you work, or if you do want to work does he/she make it hard for you?

 

14.   Does your partner try to keep you from driving the car by taking the keys or a part of the engine?

 

15.   Does your partner have drastic mood swings?

 

16.   Does your partner become angry more easily or frequently when drinking?

 

17.   Does your partner endanger you or your children by reckless driving?

 

18.   Does your partner try to make you have sex when you don’t want to?

 

19.   Does your partner force or pressure you to commit sexual acts that you are not comfortable with?

 

20.   Does your partner neglect you or your children when you are sick or in need of medical help?

 

21.   Does your partner ever push you, shove you against a wall or restrain you by holding you to prevent you from leaving the room?

 

22.   Does your partner ever slap, punch, kick, bite, head butt, choke, pull your hair, throw things at you or burn you?

 

23.   Does your partner ever give you visible injuries (welts, bruises, cuts, lumps on the head)?

 

24.   Have you ever had to seek professional aid for any injury at a medical clinic, doctor’s office or hospital emergency room?

 

25.   Does your partner ever hurt you with an object or weapon (gun, knife, cigarette, rope, belt, etc.)?

 

26.   Has your partner ever threatened you with an object or weapon?
 

27.   Has your partner ever broken or damaged your home, possessions, property or dumped garbage in your home?

 

28.   Has your partner ever hurt or killed a pet in order to punish or frighten you?

 

29.   Has your partner ever threatened to kill himself, you, your children, family members or friends?

 

30.   Has your partner ever been violent toward your children?

 

31.   Has your partner ever molested your children (or any child) sexually or behaved towards them in an inappropriate, flirtatious way?

 

32.   Does your partner ever lock you in a room or out of the house?

 

33.   Is your partner ever violent to other people outside the family?

 

34.   Have you ever had to call the police, or wanted to, because you feared your partner?

 

35.   Has your partner ever been arrested for violence?

 

36.   When your partner senses that you cannot stand the abusive behavior any longer and are thinking about leaving, does he/she try to manipulate you to stay by making you feel guilty, threatening suicide or saying they’ll come after the kids, etc?

(Score Box Here)
Abuse Index Score

Compare your Index Score with the chart and explanation that follows the questionnaire.

ABUSE INDEX SCORE CHART:

 

A person with a score of 0 - 15 lives in a non-abusive relationship. The sorts of strains this person experiences are not unusual in modern homes, and he/she and the two partners deal with them non-violently. A person with a score in the 16 - 50 range, however, definitely does live in a home where some violence has been experienced at least once in a while. It may be that this is a relationship where the violence is just beginning, or perhaps for whatever reason it has stopped at this level of severity. But in a new relationship, there is good reason to expect it will eventually escalate into more serious forms and may occur more frequently.

A person with scores in the 51 - 100 range are in a seriously abusive situation that can, under outside pressures or with the sudden strain of a family emergency, move into the dangerously severe range. In a seriously abusive situation, serious injury is quite probable if it has not already occurred. Much of this abuse is assault, pure and simple, by a violent person. A person here needs to consider finding counseling; talking with the partner about counseling if he/she will accept the idea, or sorting things out after going to a shelter. This person should seriously consider getting help, even leaving.

A person with scores in the top range of 101 - 156 need to consider even more seriously the option of leaving the relationship at least temporarily (and possibly soon). The violence will not "take care of itself" or miraculously disappear. Over time, the chances are very good that the person's life will literally be in jeopardy more than once.

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