Lesson 1, Topic 1
In Progress
Domestic Violence Behaviors Questionnaire
Hope4Families 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? _________________) |