1. Are you both violent in the relationship?
A. Only one of you is very violent
B. Yes
C. Sometimes
D. No
2. Does your lover attack you for no reason every night?
A. Yes
B. No
C. Sometimes
D. They used to but not anymore
3. Is your lover violent especially after drinking?
A. Yes
B. No
C. Sometimes
D. They are violent regardless
4. Does your lover call you names for no reason?
A. Yes
B. No
C. Sometimes
D. They used to but not anymore
5. Has your lover’s treatment affected your everyday life?
A. Yes, a lot
B. Just a little bit
C. It used to but not anymore
D. No, not at all
6. Does your lover compare you to their exes on purpose?
A. Yes
B. No
C. Sometimes
D. Yes, but it's rare
7. Have you ever threatened to leave your lover before because of the way they treat you?
A. Yes
B. No
C. You do so sometimes
D. You’ve thought about it
8. Do you feel emotionally drained because of how your lover treats you?
A. Yes
B. No
C. Sometimes
D. Yes, but it's rare
9. Has your lover ever beaten you up?
A. Yes
B. No
C. On rare occasions
D. It almost happened once
10. Do you sometimes provoke your lover, leading him to physically abuse you?
A. Yes, all the time
B. Sometimes
C. It only happened a few times in the past
D. No, never
