1. Does your wife get into your head and convince you that you are crazy or manipulate you into thinking that what you are saying could never possibly be true?
A. Yes, she does this all of the time and makes me feel so guilty
B. She sometimes does this to make me second guess myself
C. I often feel like the blame is on me, but I am not sure if that is the truth or just in my head.
2. Does your wife ever punch, hit, slap, or push you?
A. Frequently she does when she gets really mad
B. Sometimes she does, but not every time we fight
C. Only once or twice/most of the time, she doesn’t
3. Does your wife get overly jealous whenever you give attention to anyone else, even your siblings or parents?
A. Yes, she hates when I talk to or spend time with anyone else but her
B. Sometimes she does, but not all of the time
C. She gets jealous, but not to that extreme/ No, she doesn’t get jealous
4. Do you feel like any mistake you make is inexcusable in her eyes, and no matter how much you beg or plead with her to forgive you, she will continue to hold the grudge?
A. Yes, this happens often
B. Sometimes
C. She usually doesn’t get to that extent about small things, only bigger fights
5. Does your wife care where you go or who you hang out with?
A. Absolutely. She completely controls where I go and who I spend time with
B. Sometimes she does, but nothing extreme
C. Rarely. Only if she doesn’t like one of my friends
6. If you do something your wife doesn’t like, will she refuse to talk to you or stop being intimate with you as a form of punishment?
A. Yes, all the time
B. Yes, she does, but not always
C. Sometimes she will be mad and not talk to me, but not for an extended time
7. Do you ever feel like you are constantly walking on eggshells in your own home?
A. Every day
B. Often
C. Sometimes/ Rarely
8. Do you feel like your wife constantly criticizes you and puts you down for every little thing you do?
A. Yes, all of the time
B. Frequently I do
C. Sometimes I do
9. Has your wife ever threatened you with sex, divorce, or physical harm? Have you ever been genuinely fearful for your safety?
A. Yes, it has gotten to this extent a few times. She threatens often
B. Sometimes
C. She has threatened me before with things like sex/ separation, but I have never been fearful for my safety
10. Does your wife refuse to take any responsibility for her actions?
A. Yes, she will never take responsibility and only blames me for everything
B. Most of the time
C. Sometimes
