ABUSIVE RELATIONSHIP INVENTORY
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, withhold 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 you 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 look at our relationship and find alternatives
Back to Children & Teens Program