1. Does his family typically resolve conflict by screaming and yelling at each other to get their point across?
A. Yes, always
B. Sometimes
C. No
D. I am not really sure
2. Is this behavior something that is part of his personality and has always been there or is this something new that he didn’t used to do?
A. It has always been there
B. It comes and goes, but he isn’t always like this
C. It comes and goes, but he isn’t always like this
D. It is something relatively new
3. Has he had any significant losses in his life recently that you are aware of, whether it be a family member, friend, job, etc.?
A. No
B. I am not sure
C. Yes
D. Just little things, nothing significant
4. Is your husband satisfied with his job?
A. Yes, as far as I know
B. No, there have been issues with his job i.e. not getting along with coworkers, a difficult boss, not meeting demands of the job, etc.
C. No, there have been issues with his job i.e. not getting along with coworkers, a difficult boss, not meeting demands of the job, etc.
D. Sometimes
5. Does your husband have low self-esteem?
A. No, not at all
B. Yes, definitely
C. Sometimes
D. I don’t know
6. Is your husband guarded when it comes to showing his emotions?
A. Most of the time
B. No, not really
C. Yes, definitely
D. It depends on the situation
7. Does your husband have a history of mental health issues or do you believe he is currently struggling with his mental health?
A. Yes, he has always had a tough time with his temper and reactions to things
B. Not that I know of
C. I don’t think he has in the past, but I do fear he is struggling with his mental health right now
D. He has in the past, but I don’t think there’s anything going on right now regarding his mental health
8. Does your husband seem overly stressed and anxious lately?
A. No
B. Yes, definitely
C. Yes, definitely
D. Sometimes
9. Does your husband seem to only act this way towards you, or is he cranky with everyone?
A. He is cranky all the time with everyone
B. It depends on the person, he is very sensitive
C. He seems to be this way with everyone lately, but it is not typically like him to act this way
D. It seems like it is specifically towards me
10. Did your husband have a happy childhood?
A. No, not from what I know about it
B. I am not sure
C. Yes, he definitely did
D. Sometimes it was good, sometimes it was bad
