Behavioral coping skills with Domestic Violence

 
1. Please rate any behaviors that you use or have used to cope with living in an abusive relationship, If you did not use the behavior please leave blank.
Please rate
I devised a safety plan
I put my time into my house or home
I put all my time into my children
I complied with what was asked of me by my partner
I drank too much
I went to a doctor and got prescription medications to help with depression or anxiety
I over-used prescription medicines to numb my feelings or escape
I used illegal drugs
I ate food, more than I really needed
I used pornography
I had an affair(s), or sexual encounters outside my primary relationship
I used other kinds of sexual experiences or gratification
I shopped and bought things to help myself feel better
I changed my physical appearance (e.g., hair color, clothing style)
I changed my physical appearance through medical procedures (e.g., breast augmentation, tummy tuck)
I pretended to be sick or focused on my illness and pain, so my partner would treat me better
I used physical force such as scratching, biting, or hitting my partner
I locked myself in a room
I tried to reason with my partner so things did not escalate
I threatened to call the police
I actually called the police
I talked with someone I trusted about the situation
I gave my partner an ultimatum
I avoided going home
I gave my partner extra attention or praise
I wrote in a journal
I called a domestic violence or other hotline
I played games on the computer
I worked overtime or many hours at my job
I did things around the house to stay or appear busy (e.g., dusted or cleaned windows, even if they didn't need it)
I sought legal advice(i.e., saw a lawyer, paralegal, or legal aid)
I used the justice or court system (e.g., restraining order)
I saw a counselor or therapist
I attend a support group or 12 step group
I used prayer
I became very involved in my church or religious group
I engaged in self-injury (e.g., cutting myself, hitting myself)
2. Did you ever.....(check all that apply)
3. Are you currently in an abusive relationship?
4. What kinds of abuse have you experienced in your relationship? Please check all that apply.
5. Adding together all abusive relationships you have ever been in, how long in total were you or have you been involved in abusive relationships?
6. How old are you?
7. Do you......(Check all that apply)
8. What is your ethnic/racial background?
9. What is the highest level of education you have completed?
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