| Physical Violence |
| ____ |
Slap,
punch, grab, kick, choke, push, restrain, pull hair, pinch,
bite |
| ____ |
Rape
(use of force, threats to get sex) |
| ____ |
Use of
weapons, throwing things, keeping weapons around which scare
her |
| ____ |
Abuse
of furniture, things in the home, pets, destroying her things |
| ____ |
Intimidation
(standing in the doorway during arguments, angry or threatening
gestures, use of size to intimidate, standing over her, outshouting,
driving recklessly) |
| ____ |
Uninvited
touching |
| ____ |
Threats
(verbal or nonverbal, direct or indirect) |
| ____ |
Harassment
(uninvited visits or calls, following her around, checking up
on her, embarrassing her in public, not leaving when asked) |
| ____ |
Isolation
(preventing or making it hard for her to see/talk to friends,
relatives, others) |
| ____ |
Other
(please list) |
Psychological and Economic Abuse |
| ____ |
Yelling,
swearing, being lewd, raising your voice, using angry expressions
or gestures |
| ____ |
Criticism
(name-calling, swearing, mocking, put-downs, ridicule, accusations,
blaming, use of trivializing words or gestures) |
| ____ |
Pressure
Tactics (rushing her to make decisions, using guilt/accusations,
sulking, threatening to withhold financial support, manipulating
children, abusing feelings) |
| ____ |
Interrupting,
changing topics, not listening, not responding, twisting her
words, going on and on |
| ____ |
Economic
coercion (withholding money, the car, or other resources; sabotaging
her attempts to work) |
| ____ |
Claiming
"the truth," being the authority, defining her behavior,
using "logic" |
| ____ |
Lying,
withholding information, infidelity (having sex with others) |
| ____ |
Using
pornography (e.g., magazines, movies, strip shows, home videos,
etc.) |
| ____ |
Withholding
help on childcare/housework; not doing your share or following
through on your agreements |
| ____ |
Emotional
withholding (not expressing feelings, not giving support, validation,
attention, compliments, respect for her feelings, rights, and
opinions) |
| ____ |
Not taking
care of yourself (not asking for help or support from friends,
abusing drugs or alcohol, being a "people-pleaser") |
| ____ |
Other
forms of manipulation (please list) |
(Adapted from EMERGE,
Boston, Massachusetts) |
|
|
