Domestic Violence Screening Quiz - Protective Mothers' Alliance ...

Domestic Violence Screening Quiz/?psychcentral

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Domest Violence Screening Quiz

Use this brief screening measure to help you determine if
you might need to see a mental health or other social services
professional to help you successfully deal with a domestic violence
or abusive relationship situation.

Instructions:?This is a screening measure to help you determine whether you might be involved in an abusive relationship that needs attention. This screening measure is not designed to make a diagnosis or take the place of a professional diagnosis or consultation. For each item, indicate the extent to which it is true, by checking the appropriate box next to the item.

1.?Do you feel anxious or nervous when you are around your partner?

?No
Sometimes
Regularly

2.?Do you watch what you are doing in order to avoid making your partner angry or upset?

?No
Sometimes
Regularly

3.?Do you feel obligated or coerced into having sex with your partner?

?No
Sometimes
Regularly

4.?Are you afraid of voicing a different opinion than your partner?

?No
Sometimes
Regularly

5.?Does your partner criticize you or embarrass you in front of others?

?No
Sometimes
Regularly

6.?Does your partner check up on what you have been doing, and not believe your answers?

?No
Sometimes
Often

7.?Is your partner jealous, such as accusng you of having affairs?

?No
Sometimes
Often

8.?Does your partner tell you that he or she will stop beating you when you start behaving yourself?

?No
Yes

9.?Have you stopped seeing your friends or family because of your partner?s behavior?

?No
Yes

10.?Does your partner?s behavior make you feel as if you are wrong?

?No
Sometimes
Regularly

11.?Does your partner threaten to harm you?

?No
Sometimes
Regularly

12.?Do you try to please your partner rather than yourself in order to avoid being hurt?

?No
Sometimes
Regularly

13.?Does your partner keep you from going out or doing things that you want to do?

?No
Sometimes
Regularly

14.?Do you feel that nothing you do is ever good enough for your partner?

?No
Sometimes
Regularly

15.?Does your partner say that if you try to leave him or her, you will never see your children again?

?No
Yes
Not applicable

16.?Does your partner say that if you try to leave, he or she will kill himself or herself or you?

?No
Sometimes
Regularly

17.?Is there always an excuse for your partner?s behavior? (?The alcohol or drugs made me do it! My job is too stressful! If dinner was on time I wouldn?t have hit you! I was just joking!?)

?No
Sometimes
Regularly

18.?Do you lie to your family, friends and doctor about your bruises, cuts and scratches?

?No
Yes
Not applicable

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Source: http://protectivemothersalliance.wordpress.com/2011/06/18/416/

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