The intent of this survey is not to dispense legal nor medical advice or to render a psychological diagnosis. The intent rather is to offer information of a general nature and help inform survey participants regarding behavioral traits and patterns. Should at any time a risk of exposure to danger be present, it is strongly recommended that law enforcement or the appropriate government agency be contacted for assistance.

This survey is completely anonymous- we do not collect any contact data from survey participants unless you subscribe to our newsletters and videos.

Have you or your partner ever been under the influence of drugs or alcohol when aggressive or abusive towards anyone?
Yes  No

Have you or your partner ever been greatly impaired while under the influence of drugs or alcohol while acting violently?
Yes  No

Have you or your partner, while under the influence of drugs or alcohol, ever been helpless during this time and requested help or created a situation that caused someone to offer help?
Yes  No

Have you or your partner experienced more than two emergencies, crisis, or issues that need immediate attention within one 30 day period?
Yes  No

Have you or your partner often used crisis emergencies to draw in help and ask for assistance from others?
Yes  No

Have you or your partner ever tortured, taunted, or killed pets?
Yes  No

Have you or your partner ever tortured, taunted, or harmed children?                                
Yes  No

Have you or your partner ever created a fearful atmosphere for others?
Yes  No

Have you or your partner ever been punished with corporal punishment, unwanted sex, or physical torture to "teach a lesson"?
Yes  No

Have you or your partner caused an injury and then lied about how the injury occurred?
Yes  No

Have you or your partner ever threatened or attempted suicide, self-mutilation, or self-injury to compel a partner to cooperate and agree to something?
Yes  No

Have you or your partner ever physically kept anyone from leaving by force or by threat?
Yes  No

Have you or your partner claimed to be the final moral authority, talk to God directly on the behalf of others, or felt entitled to make all the family decisions?
Yes  No

Have you or your partner ever removed, seized, or hidden resources from someone such as a cell phone, a car, car keys, money, credit cards, a driver’s license, ID, etc.?
Yes  No

Have you or your partner ever made degrading and negative remarks about one’s earning ability, self-sufficiency, or independence? (e.g., "You can't make it on your own, you will never get a job, you are nothing without me.")
Yes  No

Have you or your partner experienced moodiness and exhibited patterns alternating between good/quiet periods and emotional/violent/hostile periods?
Yes  No

Have you or your partner created arguments, tension, or at times explode with emotion in order to blow off steam.
Yes  No

Have you or your partner ever asked for forgiveness and promised “it will never happen again” after an argument or fight?
Yes  No

Have you or your partner ever destroyed property, slammed doors, or screamed at family members?
Yes  No

Have you or your partner ever offered gifts, flowers, chocolate or other endearing objects after a fight or argument?
Yes  No

Have you ever received mysterious notes, emails, or seen unauthorized on-line postings about yourself?
Yes  No

Has an acquaintance or friend ever shown-up unexpectedly or “by coincidence” several times over a short period of time that seems like these appearances were actually planned?
Yes  No

Have you ever asked to be left alone but your partner ignores your requests?
Yes  No

Does a person you asked to leave you alone attempt to contact you through others and attempt to use others pressure you?
Yes  No

Have you asked someone to leave then they quickly disconnect and just as suddenly to appear months or years after having had no contact?
Yes  No