Have you refused to speak with your partner for some time (a few hours, a day or for more than a day), refused to eat the food they have cooked or slept in a different room away from the bedroom you share in the last twelve months?

Have you done any of these things [involving emotional intimate partner violence] in the past 12 months?

Have you forbidden any of your partners to have contact with family members or friends in the last year?

Have you been belittled or humiliated by a partner in front of other people?

How many times has your current or any other partner ever belittled or humiliated you in front of other people?

Have you threated to hurt any of the children (yours or your partner’s) to get any of your partners to do what you wanted or to punish them in the last year?

Have you threatened to hurt your partner or someone who is important to her in the last twelve months?

Have you threatened to hurt your wife or someone who is important to her in the last twelve months?

Have you insulted your partner or deliberately made her feel bad about herself in the last twelve months?

Have you insulted your spouse or deliberately made her feel bad about herself in the last twelve months?