PART I: PHYSICAL ABUSE
Has your partner done any of these things to you?

• Pushed or shoved you
• Held you to keep you from leaving
• Slapped or bit you
• Kicked or choked you
• Hit or punched you
• Thrown objects at you
• Locked you out of the house
• Abandoned you in dangerous places
• Subjected you to reckless driving
• Raped you
• Threatened or hurt you with a weapon
• Twisted your arm
• Tripped you
• Pulled your arm
• Banged your head against the wall
• Tied you down

PART II: SEXUAL ABUSE
Has your partner ever done any of these things to you?

• Told anti-woman jokes or made demeaning remarks about women
• Treated women/men as sex objects
• Been jealously angry, assuming you would have sex with any available man/woman
• Insisted that you dress in a more sexual way than you wanted
• Minimized the importance of your feelings about sex
• Criticized you sexually
• Insisted on uncomfortable touching
• Withheld sex and affection
• Called you sexual names like “whore” or “frigid”
• Forced you strip when you didn’t want to
• Publicly showed physical interest in other women/men
• Had affairs with other women/men
• Forced sex with him or others or forced you to watch others
• Forced particular unwanted sexual acts
• Forced sex after beating
• Forced sex when you were sick or when it was dangerous to your health
  

PART III: EMOTIONAL ABUSE
Has your partner ever done any of these things to you?

• Ignored your feelings
• Ridiculed or insulted women as a group
• Ridiculed or insulted your most valued beliefs, your religion, race, heritage, or class
• Withheld approval, appreciation, or affection as punishment
• Continually criticized you, called you names, or shouted at you
• Insulted or drove away your family and friends
• Humiliated you in public or private
• Refused to socialize with you
• Kept you from working, controlled your money, or made all decisions regarding finances
• Took car keys or money away
• Regularly threatened to leave or told you to leave
• Threatened to hurt you or your family
• Punished or deprived the children when s/he was angry at you
• Threatened to kidnap the children if you left him/her
• Abused pets to hurt you
• Told you about his/her affairs
• Harassed you about affairs s/he imagined you were having
• Manipulated you with lies and contradictions
• Demeaned and put you down by saying you couldn’t manage without masculine help
• Controlled all the money
• Not allow you to make any decisions
• Intimidated and belittled you
• Showed sarcasm towards you
• Rejected you
• Criticized you for the way you raise your children
• Called you names
• Blamed you for the violence
• Insulted you
• Refused to talk or listen to you
• Controlled you with his/her possessiveness and jealousy
• Intercepted your mail or telephone calls
• Dampened your enthusiasm
• Made you nervous and upset over being a few minutes late