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How Serious Was Your Abuse?
* Score the Black questions (1-20): Frequently (3) – Sometimes (2) – Rarely
(1) – 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?
Compare your Index Score with the chart and
explanation that follows the questionnaire.
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