Never

Once

Twice

3–5 Times

6–10 Times

11–20 Times

More Than 20 Times

1.

A.

Have you discussed the issue calmly

o

o

o

o

o

o

o

B.

Has your spouse discussed the issue calmly

o

o

o

o

o

o

o

2.

A.

Have you gotten information to back up your side of things

o

o

o

o

o

o

o

B.

Has your spouse/partner gotten information

o

o

o

o

o

o

o

4.

A.

Have you tried to bring in someone to help settle things

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

5.

A.

Have you insulted or sworn at your spouse/ partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

6.

A.

Have you sulked and/or refused to talk about it

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

7.

A.

Have you stomped out of the room, house, or yard

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

8.

A.

Have you cried

o

o

o

o

o

o

o

B.

Has your spouse/ partner cried

o

o

o

o

o

o

o

9.

A.

Have you done or said something to spite your spouse/partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o

13.

A.

Have you threatened to hit or throw something at your spouse/partner

o

o

o

o

o

o

o

B.

Has your spouse/partner

o

o

o

o

o

o

o



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement