ABUSIVE BEHAVIOR INVENTORY
Client No. 1 Client No. 2
Past Now Past Now PHYSICAL ABUSE
____ ____ ____ ____ Block the way, stand in doorway
____ ____ ____ ____ Hold captive, keep from leaving the house
____ ____ ____ ____ Lock out of shared home
____ ____ ____ ____ Refuse to help sick, injured, or pregnant partner
____ ____ ____ ____ Abandon partner in a dangerous place
____ ____ ____ ____ Push or shove
____ ____ ____ ____ Grab or hold
____ ____ ____ ____ Pin to floor, bed, wall
____ ____ ____ ____ Throw down or knock down
____ ____ ____ ____ Slap
____ ____ ____ ____ Hit with fist
____ ____ ____ ____ Twist arm
____ ____ ____ ____ Pull hair
____ ____ ____ ____ Kick
____ ____ ____ ____ Bite
____ ____ ____ ____ Pinch
____ ____ ____ ____ Pull hair
____ ____ ____ ____ Butt heads
____ ____ ____ ____ Choke, put hands to throat
____ ____ ____ ____ Throw objects at partner
____ ____ ____ ____ Hit with an object
____ ____ ____ ____ Hit, shove, or kick pregnant partner
____ ____ ____ ____ Use a weapon to hurt or threaten
____ ____ ____ ____ Cause bruises, cuts, black eyes
____ ____ ____ ____ Cause broken bones
____ ____ ____ ____ Cause impaired vision or hearing
____ ____ ____ ____ Burn or scald
____ ____ ____ ____ Cause hospitalization
____ ____ ____ ____ Injure or disfigure permanently
____ ____ ____ ____ Prevent from receiving medical care
____ ____ ____ ____ Kill or attempt to kill
VERBAL ABUSE
____ ____ ____ ____ Scream or holler
____ ____ ____ ____ Use foul language
____ ____ ____ ____ Call names
____ ____ ____ ____ Put partner down, say demeaning things
____ ____ ____ ____ Criticize frequently or continually
____ ____ ____ ____ Make fun of a disability or shortcoming
____ ____ ____ ____ Make jokes at partner’s expense
____ ____ ____ ____ Ridicule or insult partner
____ ____ ____ ____ Create fear with your voice
____ ____ ____ ____ Yell in partner’s face (“nose to nose”)
____ ____ ____ ____ Manipulate with lies and contradictions
____ ____ ____ ____ Insult or drive away partner’s family or friends
____ ____ ____ ____ Ridicule or insult partner’s religion, heritage, race, class, beliefs
EMOTIONAL ABUSE
Domination
____ ____ ____ ____ Act like the boss
____ ____ ____ ____ Try to tell partner what he/she can or can’t do
____ ____ ____ ____ Force partner to do things against his/her will
____ ____ ____ ____ Treat partner as less than your equal
____ ____ ____ ____ Make important decisions without consulting partner
____ ____ ____ ____ Refuse to do your share of chores
Intimidation
____ ____ ____ ____ Prevent or impede movement
____ ____ ____ ____ Use physical size to frighten
____ ____ ____ ____ Create fear with actions, gestures, and facial expressions
____ ____ ____ ____ Remind partner of ability to hurt him/her
____ ____ ____ ____ Drive recklessly to frighten
____ ____ ____ ____ Have weapons your partner is afraid of
____ ____ ____ ____ Threaten regularly to leave or to make partner leave the relationship
____ ____ ____ ____ Threaten to hurt partner’s family or friends
____ ____ ____ ____ Threaten to take away children
____ ____ ____ ____ Threaten to hit, hurt, or abuse children
____ ____ ____ ____ Threaten to hit, hurt, or abuse partner
____ ____ ____ ____ Threaten to kill partner
____ ____ ____ ____ Threaten to hurt or kill yourself
Humiliation
____ ____ ____ ____ Ridicule or ignore feelings
____ ____ ____ ____ Ridicule or embarrass in public
____ ____ ____ ____ Ridicule or embarrass in private
____ ____ ____ ____ Force to do demeaning or degrading things
____ ____ ____ ____ Talk about an affair (real or invented) to hurt partner
Harassment
____ ____ ____ ____ Refuse to leave partner alone
____ ____ ____ ____ Follow around the house
____ ____ ____ ____ Stalk partner
____ ____ ____ ____ Accuse partner of being unfaithful
Isolation
____ ____ ____ ____ Prevent or discourage partner from seeing family or friends
____ ____ ____ ____ Refuse to let partner leave the house
____ ____ ____ ____ Refuse to let partner go to work or school
____ ____ ____ ____ Take away car keys or money
____ ____ ____ ____ Refuse to socialize with partner
____ ____ ____ ____ Refuse to let partner be alone in public
____ ____ ____ ____ Monitor partner, interrogate about where he/she has been
Withdrawal
____ ____ ____ ____ Withhold approval, appreciation, or affection to punish
____ ____ ____ ____ Withhold sex to punish
____ ____ ____ ____ Sulk angrily to get even
Self-destruction
____ ____ ____ ____ Hit or injure yourself
____ ____ ____ ____ Place yourself in dangerous situations
____ ____ ____ ____ Attempt suicide
Using the children
____ ____ ____ ____ Turn children against partner
____ ____ ____ ____ Use visitation to harass partner
____ ____ ____ ____ Punish or deprive children when angry at partner
Destruction of property and pets
____ ____ ____ ____ Threaten to destroy property
____ ____ ____ ____ Drop plants or dishes
____ ____ ____ ____ Break a window
____ ____ ____ ____ Punch or kick a wall, door, doorjamb, etc.
____ ____ ____ ____ Slam doors
____ ____ ____ ____ Smash objects (TV, stereo, phone, remote control)
____ ____ ____ ____ Destroy something of emotional significance
____ ____ ____ ____ Threaten to harm a pet
____ ____ ____ ____ Neglect, harm, or kill a pet
SEXUAL ABUSE
____ ____ ____ ____ Express intense jealousy
____ ____ ____ ____ Tell demeaning sexual jokes
____ ____ ____ ____ Treat others as sex objects
____ ____ ____ ____ Show sexual interest in others when with partner
____ ____ ____ ____ Have an affair when you agreed to be monogamous
____ ____ ____ ____ Minimize importance of partner’s feelings about sex
____ ____ ____ ____ Criticize sexual performance or frequency
____ ____ ____ ____ Insist that partner dress more seductively or less seductively
____ ____ ____ ____ Insist on unwanted touching or other sexual activity
____ ____ ____ ____ Threaten to retaliate if partner isn’t interested in sex
____ ____ ____ ____ Force partner to watch pornography
____ ____ ____ ____ Force your partner into sexual activity
FINANCIAL ABUSE
____ ____ ____ ____ Completely control the finances
____ ____ ____ ____ Refuse to let partner have his/her own checkbook
____ ____ ____ ____ Make partner ask for money
____ ____ ____ ____ Threaten to hurt partner financially
____ ____ ____ ____ Take money or steal property
____ ____ ____ ____ Threaten to withdraw financial support
____ ____ ____ ____ Refuse to pay your share of bills as agreed
LEGAL SYSTEM ABUSE
____ ____ ____ ____ Violate a restraining order
____ ____ ____ ____ Violate a child custody agreement
____ ____ ____ ____ Lie about partner to police or in court
FIRST INCIDENT:
LAST INCIDENT:
WORST INCIDENT:
