Silence Hurts
Alcohol Abuse and Violence Against Women
Assessing Psychological Abuse
Have you ever experienced psychological abuse?1
Check off all that apply to your situation. Please use the following codes:
1 = Has not occurred
2 = Threatened
3 = Once
4 = Two to four times
5 = Five or more times, frequently
Isolation
_____ Locked in a house, room, or closet
_____ Tied up with rope, chains, handcuffs, etc.
_____ Forced to live in isolated settings
_____ Frequently change residences
_____ Controlled socialization with family or friends
_____ Monitored use of telephone/mail
Degradation
_____ Cursing or name-calling, such as stupid, worthless etc.
_____ To deprecate
_____ Public humiliation
_____ Private humiliation
_____ Denial of power or competency
_____ Forced prostitution or sex acts with others
_____ Forced pornography
_____ Rejection (emotional, intellectual, social, sexual, affectional)
Denial of Reality
_____ Denial of power or competency
_____ Told or convinced that you are mentally ill
_____ Lying to and manipulating you
_____ Attempting to induce self-doubt through shame, guilt or fear
Induced Physical Distress or Exhaustion
_____ Forced to take on role of servant
_____ Forced to clean house or work excessively long hours
_____ Obsessive needs for cleanliness, such as towels placed just right
_____ Interference with sleep patterns
_____ Interference with meals and nutrition
_____ Not allowed personal or rest time
Alcohol or Drug Administration
_____ Forced to use alcohol or other drugs
_____ Forced to participate in sale/distribution of drugs
_____ Induced dependence upon drugs
Monopolizing of Perceptions
_____ Pathological jealousy
_____ Controlled activities
_____ Economic control
_____ Checking up on where partner is (surveillance)
_____ Forced partner to live up to abuser's expectations
_____ Refuse discussions or negotiations
Threats to kill
_____ Threats to kill partner or children
_____ Threats to kill others
_____ Threats to commit suicide
_____ Threats using weapons
_____ Sham executions
_____ Threats to kidnap or keep children
[1] Created by Dr. Lenore Walker, Domestic Violence Institute, Denver, Colorado.








