Mark any of the following that you have experienced from your partner either currently
or in the past…
Emotional Abuse
- Ignored your feelings
- Ridiculed or insulted your gender as a whole
- Made comments about your gender being good for only one thing
- Ridiculed or insulted your valued beliefs (i.e. religion, education)
- Withheld approval, appreciation or affection as punishment
- Continually criticized you, called you names, shouted at you, etc.
- Insulted or drove away family or friends
- Humiliated you in private or public, refused to socialize with you
- Kept you from working, controlled all the money, made all decisions
- Refused to work or contribute to the family
- Taken car keys or money from you
- Threatened to leave or told you to leave, more than once
- Threatened to hurt you or your family
- Threatened to hurt him/herself
- Punished or deprived your children when he was angry at you
- Threatened to kidnap your children if you leave
- Abused household pets to hurt you
- Told you about affairs/outside relationships to hurt you
- Manipulated you with lies and contradictions
- Told you about drug/alcohol use as a means to hurt you
Physical Abuse
- Pushed, shoved or grabbed at you
- Prevented you from leaving, interfered with your personal liberty
- Slapped you
- Kicked, pinched or bit you
- Beaten you
- Tied you up/locked you up
- Locked you out of the house/forced you to remain outside
- Abandoned you while out
- Refused to help you when you were sick, injured or pregnant
- Subjected you to reckless driving (with or without substance abuse)
- Vehicular endangerment while you are driving or kept you from driving
- Sexually assaulted you
- Threatened to harm or kill you
- Threatened to or did hurt you with or without a weapon
Sexual Abuse
- Told anti-gender jokes or put down your gender in general
- Treated women or men as sex objects—“That’s all they’re good for” attitude
- Been jealously angry, accusing you of being willing to have sex with anyone
- Controlling how you dress; to be more or less “sexy”
- Minimized or ignored your feelings towards sex
- Criticized you sexually
- Insisted on unwanted and uncomfortable touching
- Withheld sex and affection as a form of punishment
- Calls you sexual names: whore, slut, etc.
- Forced you to strip when you did not want to
- Showed sexual interest in other men/women in public
- Had sex with other people after agreeing to a monogamous relationship
- Forced you to have sex with him/her or another person
- Forced you to watch others having sex
- Forced you to participated in unwanted sexual acts: oral sex, etc.
- Forced you to participate in sexual activities when you were sick
- Forced you to participate in sexual activities for the purpose of hurting you
- Committed sadistic sexual acts
- Used sex as a form of controlling you
Results or Responses to Abuse
Which of the following statements best describe the way you feel?
- I am often in doubt of my judgment or wonder if I am crazy
- I am often afraid of my partner’s reaction
- I express my opinion less freely or frequently than I would like
- I am afraid of other people
- I see people/friends/family less frequently than I would like
- I spend a lot of time watching for my partner’s moods before bringing up certain
subjects, etc
- I worry about, or ask permission to spend money, take classes or socialize with
friends/family
- I have lost all or some confidence in my abilities
- I feel trapped, powerless, hopeless
- I feel that I have changed in a negative way since becoming involved in this
relationship
- I feel that my partner has changed in a negative way
- I feel that my interests and needs do not matter in the relationship
The amount of checked items on your list is not important. What is important is that you
recognize the signs and forms of abuse and the presence of abuse in your life. No one
has the right to abuse another person, EVER.
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