ARE YOU ISOLATED? Circle one answer for each question.
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Does your partner intercept your mail or telephone calls?
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Often
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Sometimes
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Never
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Does your partner become angry or upset, dampening your enthusiasm, just before, or during a social event you’ve looked forward to?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Do you have fewer contacts and activities with friends and family than before you began the relationship?
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Often
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Sometimes
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Never
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Do you feel uneasy about being with your partner and your friends at the same time?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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IS YOUR ATTENTION MONOPOLIZED BY THE ABUSIVE PERSON?
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Do you feel your clothing, opinions and decisions must have your partner’s approval?
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Often
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Sometimes
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Never
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Do you feel overpowered by your partner’s presence whether or not he or she is with you?
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Often
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Sometimes
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Never
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Do you speak carefully, or avoid speaking, so you won’t risk upsetting your partner?
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Often
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Sometimes
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Never
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Do you time your activities to avoid their being noticed by your partner?
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Often
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Sometimes
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Never
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Do you often feel like you are walking on eggshells?
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Often
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Sometimes
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Never
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DOES YOUR PARTNER CLAIM TO BE ALL-POWERFUL?
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Does your partner claim to be exceptionally bright or knowledgeable, or to have extraordinary powers?
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Often
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Sometimes
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Never
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Does your partner claim to be more aware of the ways of the world than you are?
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Often
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Sometimes
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Never
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Does your partner claim to have friends and contacts who will report your activities when you are away from home?
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Often
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Sometimes
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Never
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Does your partner claim to know the right way to do things, and that you don’t know what is right?
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Often
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Sometimes
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Never
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DOES YOUR PARTNER ENFORCE TRIVIAL DEMANDS?
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Often
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Sometimes
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Never
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Does your partner interrupt your work or other things that are important to you, to get his or her needs met?
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Often
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Sometimes
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Never
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Does your partner demand that you wear only approved clothing, jewelry...?
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Often
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Sometimes
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Never
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Does your partner insist that you perform menial services, or inspect your work and make hyper-critical comments?
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Often
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Sometimes
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Never
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Does your partner demand detailed reports of your hourly activities?
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Often
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Sometimes
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Never
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ARE YOU EXHAUSTED, DEPENDENT, OR DEBILITATED?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Do you often have feelings of dread?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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DO YOU FEEL HUMILIATED OR DEGRADED?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Does your partner tell you that no one else would want you?
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Often
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Sometimes
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Never
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Has your partner talked you into doing something, and then made you feel guilty or ashamed of it?
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Often
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Sometimes
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Never
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Does your partner keep you up late, asking about real or imagined sexual or romantic incidents?
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Often
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Sometimes
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Never
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Does your partner force you to apologize for things you didn’t do?
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Often
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Sometimes
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Never
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Does your partner insist that you ask permission to spend money for household or personal items, whether the money is a community fund or your own income?
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Often
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Sometimes
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Never
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Does your partner call you names with sexual connotations such as slut or whore?
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Often
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Sometimes
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Never
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Does your partner flaunt relationships or flirt with others while in your presence?
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Often
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Sometimes
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Never
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DOES YOUR PARTNER THREATEN YOU?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Does your partner tell you that suicide or mental illness will result if you leave or withdraw your love?
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Often
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Sometimes
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Never
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Does your (recovered) alcoholic partner hint at the possibility of drinking again, unless you do what is required, and are certain not to upset him or her?
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Often
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Sometimes
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Never
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Does your partner threaten to punish you or teach you a lesson if you misbehave?
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Often
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Sometimes
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Never
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Does your partner threaten to take your car keys, money, or checkbook, if you don’t comply with his/her demands?
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Often
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Sometimes
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Never
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Does your partner use body or facial expressions, or noises, to show his/her anger and loss of control, in order to frighten you?
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Often
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Sometimes
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Never
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Has being hit or beaten in the past made you afraid it will happen again, if you don’t comply?
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Often
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Sometimes
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Never
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Does your partner keep guns, knives, or other weapons close at hand?
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Often
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Sometimes
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Never
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DOES YOUR PARTNER OCCASIONALLY INDULGE YOUR WISHES?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Does your partner become unexpectedly understanding about things that would ordinarily cause him/her to be angry?
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Often
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Sometimes
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Never
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After your partner has put you down, are you then indulged with affection or special care?
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Often
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Sometimes
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Never
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DOES YOUR PARTNER DO THINGS THAT MAKE YOU FEEL CRAZY?
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Does your partner suggest you are stupid or crazy, if you disagree with him/her?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Does your partner insist that the two of you are in a battle against a world full of enemies?
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Often
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Sometimes
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Never
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After abusing you, does your partner express so much sorrow, guilt or self-hate, that you become the one who comforts your partner?
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Does your partner make contradictory demands?
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Often
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Sometimes
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Never
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Does your partner contradict the positive things others say about you?
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Often
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Sometimes
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Never
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Does your partner do unrequested favors, then get angry or hurt when you don’t do something in return?
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Often
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Sometimes
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Never
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Do you distrust your feelings about yourself, your partner, or others?
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Often
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Sometimes
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Never
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Do you feel ashamed of past deeds that you were once proud of?
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Often
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Sometimes
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Never
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Are you afraid that no one would like you if they knew the real you?
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Often
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Sometimes
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Never
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Do you believe that you are the only one who can save your partner from ruin, depression, alcoholism, insanity or suicide?
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Often
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Sometimes
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Never
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Does it just happen that when you are preparing for a job interview, or an important event, you become distracted and worried by a crisis in your partner’s life that seems more important?
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Often
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Sometimes
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Never
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Does your partner cause you to question your longtime friendships?
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Often
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Sometimes
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Never
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Are you confused about what is love and what is hate? Or what is right and what is wrong?
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Often
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Sometimes
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Never
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IS YOUR PARTNER EMOTIONALLY DISTANT OR NEGLECTFUL?
Does your partner?:
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Refuse to confide in you, when he/she is worried, hurt, or scared?
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Often
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Sometimes
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Never
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Ignore your wish for sex, or refuse to do what excites or satisfies you?
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Often
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Sometimes
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Never
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Make light of your triumphs, discourage your plans, disparage your success?
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Often
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Sometimes
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Never
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Refuse to share his/her plans, or dreams for success?
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Often
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Sometimes
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Never
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Have you?:
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Often
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Sometimes
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Never
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Often
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Sometimes
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Never
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Given up asking for your partner’s help, when you are sick, or tired?
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Often
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Sometimes
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Never
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Stopped asking your partner about his/her plans, worries, or triumphs?
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Often
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Sometimes
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Never
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Developed a habit of avoiding sex, whenever possible, but, enduring it as a tolerable routine, when it is unavoidable?
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Often
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Sometimes
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Never
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