The following questionnaire is from THE FAMILY SECRET, by William A. Stacey and Anson Shupe, Center for Social Research Abuse Index.
ARE YOU IN AN ABUSIVE SITUATION?
This questionnaire is designed to help you decide if you are living in an abusive situation. There are different forms of abuse and not every person experiences all of them. Below are various questions about your relationship with your partner. As you can see, each possible answer has points assigned to it. By answering each question and then totaling these points as directed, you can compare your score with our Abuse Index. You will know if you are living in a potentially violent situation, and if you are abused, you will have some estimate of how really dangerous that abuse is.
Even if you feel that this questionnaire does not pertain to you personally, you may know someone who might benefit from it. Please show it to a friend!
Normally, the directions would be to circle the response to each question that best describes your relationship. In order to save space, we have put the answers in twice since the working of each answer and the point values are the same for several questions.
For question 1-14, the answers and point values are as follows:
1. _____ Does your partner continually monitor your time and make you account for every minute(when you run errands, visit friends, commute to work, etc?)
2. _____ Does your partner ever accuse you of having affairs or act suspicious that you are having affairs?
3. _____ Is your partner ever rude to your friends?
4._____ Does your partner ever discourage you from starting friendships with other people?
5. _____ Do you ever feel isolated and alone, as if there is nobody close to you to confide in?
6. _____ Is your partner overly critical of daily things, such as your clothing or your appearance?
7. _____ Does your partner demand a strict account of how you spend money?
8. _____ Does your partner’s mood change radically from very calm to very angry, or vice versa?
9. _____ Is your partner disturbed by you working or by the thought of you working?
10. _____ Does your partner pressure you for sex much more often than you would like?
11. _____ Does your partner become angry if you don’t want to go along with his/her requests for sex?
12. _____ Does your partner become angry more easily when drinking?
13. _____ Do you quarrel much over financial matters?
14. _____ Do you quarrel much about having children or raising them?
For question 15-27, the answers and point values are as follows:
15. _____ Does your partner ever strike you with hands or feet (slap, punch, kick, etc.)?
16._____ Does your partner ever strike you with an object?
17._____ Does your partner ever threaten you with an object or weapon?
18._____ Does your partner ever threaten to commit suicide or kill you?
19._____ Does your partner ever give you visible injuries (welts, bruises, cuts, on the head?
20._____ Have you ever had to treat any injuries from your partner’s violence with first aid?
21._____ Have you ever had to seek professional aid for any injury at a medical clinic, doctor’s office, or hospital emergency room?
22._____ Does your partner ever hurt you sexually or make you engage in sex against your will?
23._____ Is your partner ever violent toward children?
24._____ Is your partner ever violent toward other people outside your home and family?
25._____ Does your partner ever throw objects or break things when angry?
26._____ Has your partner ever been in trouble with the police?
27._____ Have you ever called the police or tried to call them because you felt you or other members of your family were in danger?
When you have gone through the entire questionnaire, score your response by adding up the points on each answer. This sum is your Abuse Index Score. To get some idea of how abusive your relationship is, compare your Index Score with the chart and explanation that follows the questionnaire.
|120 – 94||DANGEROUSLY ABUSIVE|
|93 – 37||SERIOUSLY ABUSIVE|
|36 – 15||MODERATELY ABUSIVE|
|14 – 0||NON-ABUSIVE|
A person with a score of 0 – 14 lives in a non-abusive relationship. The sorts of strains this person experiences are not unusual in modern homes, and he/she and the two partners deal with them non-violently. A person with a score in the 15 – 36 range, however, definitely does live in a home where some violence has been experienced at least once in a while. It may be that this is a relationship where the violence is just beginning, or perhaps for whatever reason it has stopped at this level of severity. But in a new relationship, there is good reason to expect it will eventually escalate into more serious forms and may occur more frequently.
A person with scores in the 37 – 93 range are in a seriously abusive situation that can, under outside pressures or with the sudden strain of a family emergency, move into the dangerously severe range. In a seriously abusive situation, serious injury is quite probable if it has not already occurred. Much of this abuse is assault, pure and simple, by a violent person. A person here needs to consider finding counseling, talking with the partner about counseling if he/she will accept the idea, or sorting things out after going to a shelter. This person should seriously consider getting help, even leaving.
A person with scores in the top range of 94 – 120 need to consider even more seriously the option of leaving the relationship at least temporarily (and possibly soon). The violence will not “take care of itself” or miraculously disappear. Over time, the chances are very good that the person’s life will literally be in jeopardy more than once.