| Am I / Is my partner a person who... |
| Was or is abused by a parent? | YES OR NO |
| Grew up in a home where an adult was abused by another adult? | YES OR NO |
| Gets very serious with boyfriends/girlfriends very quickly -saying "I love you" very early in the relationship, wnating to move in together or get engaged after only a few months or pressuring partner for a serious commitment? | YES OR NO |
| Comes on very strong, is extremely charming and an overly smooth talker? | YES OR NO |
| Is extremely jealous? | YES OR NO |
| Isoplates partner from support systems - wants partner all to themselves, and tries to keep partner from friends, family, or outside activities? | YES OR NO |
| Attempts to control what partner wears, what s/he does or who s/he sees? | YES OR NO |
| Is abusive toward other people, especially mothers or sisters if he is a male? | YES OR NO |
| Blames others for one | YES OR NO |
| Abuses drugs or alcohol? | YES OR NO |
| Has unrealistic expectations, like expecting partner to met all of one | YES OR NO |
| Is overly sensitive - acts | YES OR NO |
| Has ever been cruel to animals? | YES OR NO |
| Has ever abused children? | YES OR NO |
| has ever hit boyfriend or girlfriend in the past? | YES OR NO |
| Has ever threatened violence, even if it wasn | YES OR NO |
| Calls partner names, puts him/her down or curses at him/her? | YES OR NO |
| Is extremely moody and switches quickly from being very nice to exploding in anger? | YES OR NO |
| If a male, believes women are inferior to men and should obey them? | YES OR NO |
| Is intimidating, for example using threatening body language, punching walls, or breaking objects? | YES OR NO |
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