Domestic Abuse Components Survey

1.What is your age?(Required.)
2.What is your ethnicity?(Required.)
3.What is your self-identified gender?(Required.)
4.What is your sexual orientation?(Required.)
5.Which of the following best describes the relationship you are referring to?  (NOTE: if you have had multiple abusive partners, pick ONE to answer this survey about.  You can complete the survey more than once if you have had more than one abusive partner).(Required.)
6.My partner that I am completing this survey about is:(Required.)
7.Which of the following types of isolation did you experience in your relationship?  (Select all that apply)(Required.)
8.Please select all the aspects of your health that have been impacted by your partner.  (Select all that apply)(Required.)
9.Indicate to what extent your autonomy (your freedom to make choices about your own life) has been impacted by your partner.(Required.)
10.Indicate to what extent your identity has been impacted by your partner.(Required.)
11.Indicate to what extent your connection with reality has been impacted by your partner.  (Required.)
12.To what extent has your stability been impacted by your relationship?(Required.)
13.Manipulative Verbal Destabilization (MVD) is when your partner uses a mess of words and manipulation tactics that often lead to you feeling confused and depleted, and struggling to think clearly.  It often involves drawn-out conversations that seem to go in circles and leads to you feeling unstable and confused.  Has this happened in your relationship?(Required.)
14.DARVO is a manipulation technique where a person denies or dismisses something you brought up, then attacks or accuses you of doing something wrong (blame-shifting), and then reverses the position of victim and offender (now you are framed as the offender).  Has this happened in your relationship?(Required.)
15.Some partners will “remove” a right, and then strategically “gift” it back to you.  For example, they may refuse to let you purchase something (maybe they never allow you to buy chocolate, for example), and then one day they come home with chocolate for you.  Or, they may prevent you from sleeping, and then allow you to sleep. 

Have you experienced this situation where your partner deprives you of a certain aspect of your freedom, and then “gifts” that freedom back to you?
(Required.)
16.Do you feel like even when you are not around your partner, your brain will echo similar criticisms that you've heard from them?(Required.)
17.To what extent do you feel a pull similar to an addiction in your relationship?  (Addiction meaning you continue to feel drawn to the relationship despite negative consequences in your life).(Required.)
18.Do you sometimes feel like your partner has 2 completely different sides to them?(Required.)
19.Are there any other details that you would like to share about how you have been affected by your relationship?
20.Are you willing to be contacted about further surveys?  (please enter your email if you select "Yes").(Required.)