Answer Yes or No to the following questions:
- Before your 18th birthday, did a parent or other adult in the household often or very often…
- swear at you, insult you, put you down, or humiliate you?
or
- act in a way that made you afraid that you might be physically hurt?
YES/NO
- Before your 18th birthday, did a parent or other adult in the household often or very often…
- push, grab, slap, or throw something at you?
or
- ever hit you so hard that you had marks or were injured?
YES/NO
- Before your 18th birthday, did an adult or person at least five years older than you ever…
- touch or fondle you or have you touch their body in a sexual way?
or
- attempt or actually have oral, anal, or vaginal intercourse with you?
YES/NO
- Before your eighteenth birthday, did you often or very often feel that…
- no one in your family loved you or thought you were important or special?
or
- your family didn’t look out for each other, feel close to each other, or support each other?
YES/NO
- Before your 18th birthday, did you often or very often feel that…
- you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
or
- your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
YES/NO
- Before your 18th birthday, was a biological parent ever lost to you through divorce, abandonment, or other reason?
YES/NO
- Before your 18th birthday, was your mother or stepmother:
- often or very often pushed, grabbed, slapped, or had something thrown at her?
or
- sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?
or
- ever repeatedly hit over the head for at least a few minutes or threatened with a gun or knife?
YES/NO
- Before your 18th birthday, did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
YES/NO
- Before your 18th birthday, was a household member depressed or mentally ill, or did a household member attempt suicide?
YES/NO
- Before your 18th birthday, did a household member go to prison?
YES/NO
Exercise 4: Please turn to your workbook and write down your results