1. Does your husband blame you for things that are not your fault?
A. No, he puts the blame where it belongs
B. He blames me for EVERYTHING
C. He blames me sometimes, but it usually gets cleared up
D. He usually will blame me and will sometimes listen when I tell him it's not my fault
2. Does your husband say things that make you feel bad about yourself?
A. He has said things in the past that have hurt me
B. He doesn’t put me down, just lifts me up
C. It is a constant stream of put-downs out of his mouth
D. He has put me down once or twice
3. Does your husband mock you in front of friends and family?
A. He does sometimes, even though I’ve asked him to stop
B. He does, but he stops when I ask
C. He consistently mocks me in front of my friends and even my family
D. No, he doesn’t mock me in front of people or in private
4. Do you feel trapped in your marriage?
A. I feel trapped most days
B. I am suffocating in my marriage
C. I am happy in my marriage and do not feel trapped
D. I have felt trapped, but not anymore
5. Does your husband refuse to apologize after yelling or belittling you?
A. When my husband loses his temper, he apologizes
B. He will never apologize for anything
C. He will apologize if he feels he was wrong
D. He has apologized before and will when he feels he has really hurt me
6. When you fight, does your husband storm off after he’s done making his point?
A. He usually needs space after an argument
B. No, we process together until it’s resolved
C. He will leave the room or area after a fight
D. He usually storms off, and I don’t know when he will come back
7. Do you feel safe around your husband?
A. I feel safe if he is in a good mood
B. I do not feel safe with my husband
C. I feel completely safe with my husband
D. I feel safe with my husband most days
8. Does your husband begin fights with you?
A. He constantly starts fights and finds something wrong with everything I do
B. He doesn’t start fights with me, but we do argue
C. We do not really fight. I think we have good communication
D. He starts fights and not as often as I do
9. Does your husband disrespect you?
A. Yes, I don’t think he respects me at all
B. I feel respected by my husband
C. I feel like he respects me mostly
D. From time to time, I do not feel like my husband respects me
10. Does your husband expect that you will do what he says?
A. He listens to me as much as I listen to him
B. He expects that I will listen to him without question
C. He wants me to listen to him, but sometimes I don’t, and then he gets mad
D. He wants me to consider his ideas and instructions, but if I don’t, that’s okay