Domestic Violence Program
POWER/CONTROL
AND
EQUALITY WHEELS
 
ABUSIVE RELATIONSHIP INVENTORY
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A. NOT PHYSICALLY VIOLENT
____ 1. Sulk, refuse to talk to you
____ 2. Withdraw affection or sex to punish you
____ 3. Stomp out in order to punish you
____ 4. Scream, insult or swear at you
____ 5. Verbally pressure you to have sex
____ 6. Threaten punishment other than physical
(ex. having an affair, withold money/dates/affection)
____ 7. Threaten to leave relationship
____ 8. Threaten to tell others that you have
had sex with him/her if you refuse to do so
B. INDIRECT THREATS OF VIOLENCE
____ 1. Prevent you from leaving
____ 2. Prevent you from seeing certain people/friends
C. DIRECT THREATS OF VIOLENCE
____ 1. Direct anger at or threaten pets
____ 2. Threaten to hit or throw something at
you
____ 3. Throw, hit or kick something
____ 4. Drive recklessly to frighten you
____ 5. Direct anger at or threaten your friends/family
____ 6. Destroy your special/significant property
D. DIRECT VIOLENCE
____ 1. Throw something at you
____ 2. Push, carry, restrain, grab, shove, wrestle
with you
____ 3. Slap or spank you
____ 4. Bite or scratch you
____ 5. Throw you bodily
____ 6. Spit at you
E. SEVERE VIOLENCE
____ 1. Choke or strangle you
____ 2. Physically force sex on you
____ 3. Punch or kick you
____ 4. Burn you
____ 5. Beat you unconscious
____ 6. Threaten you with a knife, gun or other
weapon
____ 7. Use any weapon against you
If you checked any of the items above, you may need to examine
your relationship and consider your alternatives. Contact Hands
of Hope; we can help you explore your options.
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