Professional Documents
Culture Documents
Here is a list of behaviors that many women report have been used by their spouses/partners or former partners/spouses. Please estimate how often these behaviors occurred during the past six months. CIRCLE a number for each of the items listed below, estimating how often the event happened in your relationship during the PAST SIX MONTHS.
# Question Never 1 Rarely 2 Rarely 2 Rarely 2 Occasionally 3 Occasionally 3 Occasionally 3 Frequently 4 Frequently 4 Frequently 4 Very Frequently 5 Very Frequently 5 Very Frequently 5 Not Applicable
Called you a name and/or criticized you Tried to keep you from doing something you wanted to do (example: going out with friends, going to meetings) Gave you angry stares or looks Prevent you from having money for your own use Ended a discussion with you and made the decision himself Threatened to hit or throw something at you Pushed, grabbed, or shoved you Put down your family and friends
Never 1 Never 1
Not Applicable
Not Applicable
Never 1 Never 1
Rarely 2 Rarely 2
Occasionally 3 Occasionally 3
Frequently 4 Frequently 4
Not Applicable
Not Applicable
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
Never 1 Never 1
Rarely 2 Rarely 2
Occasionally 3 Occasionally 3
Frequently 4 Frequently 4
Not Applicable
Not Applicable
Accused you of paying too much attention to someone or something else Put you on an allowance Used your children to threaten you (example: told you that you would lose custody, said he would leave town with the children) Became very upset with you because dinner, housework, or laundry was not ready when he wanted it or done the way he thought it should be Said things to scare you (examples: told you something bad would happen, threatened to commit suicide) Slapped, hit, or punched you Made you do something humiliating or degrading (example: begging for forgiveness, having to ask his permission to use the car or do something)
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
10
Never 1 Never 1
Rarely 2 Rarely 2
Occasionally 3 Occasionally 3
Frequently 4 Frequently 4
Not Applicable
11
Not Applicable
12
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
13
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
14
Never 1 Never 1
Rarely 2 Rarely 2
Occasionally 3 Occasionally 3
Frequently 4 Frequently 4
Not Applicable
15
Not Applicable
16
Checked up on you (examples: listened to your phone calls, checked the mileage on your car, called you repeatedly at work) Drove recklessly when you were in the car Pressured you to have sex in a way that you didnt like or want Refused to do housework or childcare Threatened you with a knife, gun, or other weapon Spanked you Told you that you were a bad parent
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
17
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
18
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
19
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
20
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
21
Never 1
Not Applicable
22
Never 1
Not Applicable
23
Stopped you or tried to stop you from going to work or school Threw, hit, kicked, or smashed something
Never 1
Not Applicable
24
Never 1
Rarely 2
Occasionally 3
Frequently 4
Very Frequently 5
Not Applicable
25
Kicked you
Never 1
Rarely 2 Rarely 2
Occasionally 3 Occasionally 3
Frequently 4 Frequently 4
Not Applicable
26
Never 1
Not Applicable
27
Never 1
Rarely 2 Rarely 2
Occasionally 3 Occasionally 3
Frequently 4 Frequently 4
Not Applicable
28
Physically attacked the sexual parts of your body Choked or strangled you Used a knife, gun, or other weapon against you
Never 1
Not Applicable
29
Never 1 Never 1
Rarely 2 Rarely 2
Occasionally 3 Occasionally 3
Frequently 4 Frequently 4
Not Applicable
30
Not Applicable