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 Posted: Mon Sep 19, 2011 9:20 am
Enter the number of points next to each question depending on the severity of each item:
Never: 0 points
Rarely: 1 point
Sometimes: 2 points
Frequently: 3 points
__ My partner teases me in a hurtful way in private or in public
__ My partner calls me names such as "stupid" or "b***h"
__ My partner acts jealous of my friends, family, or co-workers
__ My partner gets angry about clothes I wear or how I style my hair
__ My partner checks up on me by calling, driving by, or getting someone else to
__ My partner insists on knowing who I talk to on the phone
__ My partner blames me for their problems or bad mood
__ My partner gets angry easily, leaving me walking on eggshells
__ My partner throws or destroys things when angry
__ My partner hits walls, drives dangerously or does other things to scare me
__ My partner drinks excessively or uses drugs
__ My partner insists that I drink or use drugs whenever they do
__ My partner accuses me of being interested in someone else
__ My partner reads my mail, goes thru my personal space/items (ie. purse)
__ My partner keeps me from getting a job or finds ways to cause problems at my job
__ My partner keeps money from me, keeps me in debt, or has "money secrets"
__ My partner sold my car, made me give up my license, or won't repair my car
__ My partner has threatened to hurt me
__ My partner has threatened to hurt my children
__ My partner has actually hurt my children
__ My partner has threatened to hurt my pets
__ My partner has actually hurt my pets
__ My partner has threatened to hurt my friends or family
__ My partner has hurt a friend or family member
__ My partner has threatened to commit suicide if I leave
__ My partner has struck me with hands or feet - slapped, punched, kicked
__ My partner has struck me with an object or threatened me with a weapon
__ My partner has given me visible injuries - bruises, welts, cuts
__ I have had to administer first aid to myself due to injuries from my partner
__ My injuries have been serious enough to seek treatment - doctor, hospital, clinic, paramedic
__ My partner forces me to have sex when I don't want to
__ My partner forces me to have sex in ways that I don't want to
__ My partner has been in trouble with the police
__ My partner acts one way in front of others, and another way when we are alone
__ My partner is secretive or lies about past relationships
__ I feel isolated and alone and have no one I can really talk to
__ I have lost friends because of my partner/partner's actions
__ I no longer see some of my family because of my partner
__ I have thought about calling the police because of an incident of violence
__ I have actually called the police on one or more occasions
__ I am afraid to call the police because of threats from my partner
_____ TOTAL POINTS
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Posted: Mon Sep 19, 2011 9:21 am
0-17: Generally Non-abusive
These are likely to be the sorts of strains that are not unusual in relationships. Do NOT, however, make the mistake of brushing off any incident of violence or threat of violence, no matter how isolated!
18-58: Moderately Abusive
This is a home experiencing some violence at least once in a while. It may be that this is a relationship where violence is just beginning. In a new relationship there is good reason to expect it will eventually escalate into more serious forms and may occur more frequently.
59-95: Seriously Abusive
Scores in this range indicate a seriously abusive relationship that can, under outside pressure, or with the sudden strain of a family emergency, move into the dangerously severe range. Serious injury is quite probable if it has not already occurred. Please consider getting help, even leaving.
96 and up: Dangerously Abusive
If you scored in the top range, you need to consider even more seriously the option of leaving, at least temporarily, while you consider your next move. The violence will not take care of itself or miraculously disappear. Over time the chances are very good that your life and/or the lives of your children will be in danger.
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