Below is a list of some things partners do while they are arguing. Please indicate how often each happened.

1=once in past year 2=twice in past year 3=3-5 times in past year 4=6-10 times in past year 5=11-20 times in the past year 6=more than 20 times in the past year

How many times in the past year have you:

1. Have you showed your partner you cared even though you disagreed?
2. Has your partner showed care for you even though you disagreed?
3. Have you explained your side of a disagreement to your partner?
4. Has your partner explained his/her side of a disagreement to you?
5. Have you thrown something at your partner that could hurt?
6. Has your partner thrown something at you that could hurt?
7. Have you insulted or sworn at your partner?
8. Has your partner insulted or sworn at you?
9. Have you twisted your partner’s arm or hair?
10. Has your partner twisted your arm or hair?
11. Have you had a sprain, bruise or small cut because of a fight with your partner?
12. Has your partner had a sprain, bruise or small cut because of a fight with you?
13. Have you shown respect for your partner’s feelings about an issue?
14. Has your shown respect for your feelings about an issue?
15. Have you made your partner have sex without a condom?
16. Has your partner made you have sex without a condom?
17. Have you pushed or shoved your partner?
18. Has your partner pushed or shoved you?
19. Have you used force (like hitting, holding down, or using a weapon) to make your partner have anal or oral sex?
20. Has your partner used force (like hitting, holding down, or using a weapon) to make you have oral or anal sex?
21. Have you used a knife or gun on your partner?
22. Has your partner used a knife or gun on you?
23. Have you passed out from being hit on the head by your partner in a fight?
24. Has your partner passed out from being hit on the head by you in a fight?
25. Have you called your partner fat or ugly?
26. Has your partner called you fat or ugly?
27. Have you punched or hit your partner with something that could hurt?
28. Has your partner punched or hit you with something that could hurt?
29. Have you destroyed something belonging to your partner?
30. Has your partner destroyed something belonging to you?
31. Have you gone to the doctor because of a fight with your partner?
32. Has your partner gone to the doctor because of a fight with you?
33. Have you choked your partner?
34. Has your partner choked you?
35. Have you shouted or yelled at your partner?
36. Has your partner shouted or yelled at you?
37. Have you slammed your partner against a wall?
38. Has your partner slammed you against a wall?
39. Have you said you were sure that you and your partner could work out a problem?
40. Has your partner said that he/she was sure that you and your partner could work out a problem?
41. Have you needed to see a doctor because of a fight with your partner, but didn’t?
42. Has your partner needed to see a doctor because of a fight with you, but didn’t?
43. Have you beat up your partner?
44. Has your partner beat you up?
45. Have you grabbed your partner?
46. Has your partner grabbed you?
47. Have you used force (like hitting, holding down, or using a weapon) to make your partner have sex?
48. Has your partner used force (like hitting, holding down, or using a weaponto make you have sex?
49. Have you stomped out of the room or house or yard during a disagreement?
50. Has your partner stomped out of the room or house or yard during a disagreement?
51. Have you insisted on sex when your partner did not want to (but did not use physical force)?
52. Has your partner insisted on sex when you did not want to (but did not use physical force)?
53. Have you slapped your partner?
54. Has your partner slapped you?
55. Have you had a broken a bone from a fight with your partner?
56. Has your partner had a broken a bone from a fight with you?
57. Have you used threats to make your partner have oral or anal sex?
58. Has your partner used threats to make you have oral or anal sex?
59. Have you suggested a compromise to a disagreement?
60. Has you partner suggested a compromise to a disagreement?
61. Have you burned or scaled your partner on purpose?
62. Has your partner burned or scalded you on purpose?
63. Have you insisted on oral or anal sex when your partner did not want to (but did not use physical force)?
64. Has your partner insisted on oral or anal sex when you did not want to (but did not use physical force)?
65. Have you accused your partner of being a lousy lover?
66. Has your partner accused you of being a lousy lover?
67. Have you done something to spite your partner?
68. Has your partner done something to spite you?
69. Have you threatened to hit or throw something at your partner?
70. Has your partner threatened to hit or throw something at you?
71. Have you felt a physical pain that still hurt the next day because of a fight with your partner?
72. Has your partner felt a physical pain that still hurt the next day because of a fight with you?
73. Have you kicked your partner?
74. Has your partner kicked you?
75. Have you used threats to make your partner have sex?
76. Has your partner used threats to make you have sex?
77. Have you agreed to try a solution to a disagreement your partner suggested?
78. Has your partner agreed to a solution to a disagreement that you suggested?