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Lesson 1, Topic 1
In Progress

Domestic Violence Behaviors Questionnaire

H4FAdmin August 26, 2022

RAGE. Goal = to destroy. May include partial or total loss of awareness. May result in severe damage
to self or partner.

Done by You:Done to You:
_____Murder or attempted murder_____Murder or attempted murder
_____Broken bones_____Broken bones
_____Bad bruises_____Bad bruises
_____Choking to unconsciousness_____Choking to unconsciousness
_____Violent rape_____Violent rape
_____Deep bite wounds_____Deep bite wounds
_____Stabbing_____Stabbing
_____Stomping (repeated kicking)_____Stomping (repeated kicking)
_____Other (What? _________________________)_____Other (What? ________________________)

PARTLY CONTROLLED VIOLENCE. Goal = to get what I want or to retaliate against the other person for
something they have done. May cause injuries but usually less severe than with rage.

Done by You:Done to You:
_____Hitting _____Hitting 
_____Choking/suffocating_____Choking/suffocating
_____Hard shoving or pushing_____Hard shoving or pushing
_____Pounding, punching _____Pounding, punching 
_____Throwing against wall_____Throwing against wall
_____Kicking_____Kicking
_____Biting_____Biting
_____Twisting skin or limbs_____Twisting skin or limbs
_____Slapping_____Slapping
_____Burning_____Burning
_____Forced sex_____Forced sex
_____Taking children from partner returning or not returning them_____Taking children from partner returning or not returning them
_____Other (What? ___________________)_____Other (What? ___________________)

RESTRAINING BEHAVIORS. Goal = to keep partner from leaving. This is a serious violation of another’s rights

Done by You:Done to You:
_____Holding on to other_____Holding on to other
_____Blocking, locking the door._____Blocking, locking the door.
_____Taking, destroying phone_____Taking, destroying phone
_____Refusing to allow privacy_____Refusing to allow privacy
_____Following or tracking partner_____Following or tracking partner
_____Keeping partner from friends or family_____Keeping partner from friends or family
_____Keeping almost total control of money_____Keeping almost total control of money
_____Other (What? ___________________)_____Other (What? ___________________)

INTIMIDATION TACTICS. Goal = to scare partner into obedience.

Done by You:Done to You:
_____Threats of violence_____Threats of violence
_____Yelling or screaming_____Yelling or screaming
_____Name-calling, swearing_____Name-calling, swearing
_____Throwing objects_____Throwing objects
_____Breaking things (own, theirs, both)_____Breaking things (own, theirs, both)
_____Punishing kids to hurt partner_____Punishing kids to hurt partner
_____Threatening to leave_____Threatening to leave
_____Threatening to take kids_____Threatening to take kids
_____Threatening financial ruin_____Threatening financial ruin
_____Threatening to harm or kill yourself_____Threatening to harm or kill yourself
_____Other (What? ______________)_____Other (What? ______________)

SHAMING TACTICS. Goal = to destroy other person’s self-worth. Indicating in some way that the partner
or person you are fighting is no good, not good enough, unlovable, doesn’t belong, or should not even
be.

Done by You:Done to You:
___Belittling (“You’re stupid, ugly, worthless, sick…”)___Belittling
___Blaming (Anything that goes wrong is the other’s fault)___Blaming 
___Public humiliation of the other person___Humiliating
___Negative comparisons (“You’re not as good as …”)___Comparing
___Fault–finding (commenting on what the other does wrong)___Fault–finding 
___Refusal to give praise or appreciation to other___No praise
___Other (What? _____________________)___Other (What? _____________________)

PASSIVE AGGRESSIVE TACTICS. Goal = to control through negative interactions.

Done by You:Done to You:
___Ignoring the other ___Ignoring other
___Refusing to discuss serious issues (finances, etc.)___Ignoring issues
___“Forgetting” on purpose___Forgetting
___Showing up late or not at all___Showing up late
___Playing dumb (“I don’t know how”)___Acting dumb
___Stalling or going slow___Stalling
___Other (What? _____________________)___Other (What? _________________)