How Serious Was/Is Your Abuse?

Use this test to self-evaluate the level of abuse in your relationship. Go through the test twice. First, ask if your relationship has ever included the listed abuses. Second, evaluate the current state of your relationship, by answering for the last twelve months.

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1. Does he check up on you and want to know where you are at all times?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

2. Is he jealous, and does he accuse you of having affairs with other men or women?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

3. Does he tell you you are stupid, lazy, ugly, a rotten cook, a failure as a wife or mother, or no good in bed, etc.?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

4. Does he call you obscene names?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

5. Does he tell you that no one else could ever love you?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

6. Does he make fun of you in front of other people?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

7. Does he try to keep you from seeing family or friends?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

8. Does he control the family money so that you have to account for every penny and/or beg him for it?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

9. Does he forbid or demand that you work, or, if you want to work, does he make it difficult for you?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

10. Does he tell you that no one would ever hire you?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

11. Does he try to keep you from driving the car by taking your keys or a part of the engine?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

12. Does he have dramatic mood swings?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

13. Does he become angrier when he drinks?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

14. Does he try to make you have sex when you don't want to?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

15. Does he force or pressure you to commit sexual acts that you are not comfortable with or consider unnatural?

Often--------3
Sometimes--2
Rarely-------1
Never--------0

16. Has he ever broken or damaged your home, possessions, or property, or dumped garbage in your home?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

17. Has he ever hurt or killed a pet in order to frighten or punish you?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

18. Does he ever lock you in a room or out of the house?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

19. Does he ever push you, shove you against walls, or retrain you by holding you to prevent you from leaving a room?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

20. Does he ever force you to stay awake?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

21. Does he ever slap, punch, kick, bite, choke, pull your hair, or burn you?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

22. Does he ever hurt you with an object or weapon (gun, knife, cigarette, rope, belt, etc.)?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

23. Has he ever threatened you with an object or weapon?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

24. Does he endanger you or your children by reckless driving?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

25. Does he neglect you or the children when you are sick or in need of medical help?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

26. Has he ever threatened to kill himself, you, your children, or other family members or friends?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

27. Has he ever been violent toward your children?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

28. Has he ever molested your children sexually or behaved toward them in an inappropriate, flirtatious way?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

29. Is he ever violent to other people outside the family?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

30. Have you ever had to call the police, or wanted to, because you feared him?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

31. Has he ever been arrested for violence?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

32. When he senses that you cannot stand the abusive behavior any longer and are thinking about leaving, does he try to manipulate you to stay by making you feel guilty, threatening suicide, etc.?

Often--------6
Sometimes--5
Rarely-------4
Never--------0

To learn how serious your abuse has been, total your points.

• 0-14     Non abusive
• 16-36     Moderately abusive
• 37-93     Seriously abusive
• 94 or more    DANGEROUSLY ABUSIVE

_{Note: This questionnaire is based on the CSR Abuse Index, in A. Shupe and W. Stacey, The Family Secret, pp.221-222. Copyright 1983 by Anson Shupe and William Stacey. Used with permission.}