Domestic Violence Questionnaire

About you

Are you male female

Age range under 15 16 -25 26 - 35 36 - 45 46 - 55 over 55

Where do you live? England Scotland Wales Northern Ireland Eire United States Canada Australia New Zealand Other

if other, please specify

Are you

abuse victim

abuse survivor

friend or family

professional (ie welfare worker, police, etc)

student

abuser

other, please specify

If you are a victim or survivor of abuse

What types of abuse have you/do you suffer? (please tick all which apply)

If you have suffered any other form of abuse, please specify

Specific questions on types of abuse experienced:

If you have suffered Physical Abuse please tick the options that apply:

What sorts of physical assault have you experienced?

What part of your body was targeted during the physical assault(s)?

What sort of injuries have you sustained due to physical assault(s)?

About the frequency of assaults:

How soon after starting the relationship did the first physical assault take place?

How many times (approx.) have you been physically assaulted?

How many times (approx) were you assaulted BEFORE telling someone?

Have the physical assaults increased, stayed the same or decreased during your relationship?

Did the physical abuse start:

Have you ever tried defending yourself from a physical assault? no yes

If you have suffered Sexual Abuse please tick the options that apply:

What sorts of sexual abuse have you experienced?

Any other forms of sexual abuse you have experienced?

If you have been raped, did your abuser use:

About the frequency of sexual abuse:

How soon after starting the relationship did the first sexual abuse take place?

How many times (approx.) have you been sexually abused?

How many times (approx) were you sexually abused BEFORE telling someone?

Has the sexual abuse increased, stayed the same or decreased during your relationship?

If you have been raped, did you recognise it as rape at the time of the incident?

Have you sustained any injuries/diseases/pregnancy etc as a result of the sexual abuse?

Domestic Abuse and Children

Do/did you have any children while with the abuser?

Is the abuser the other biological parent of the child/children?

How many children did you have while in the abusive relationship? 1 2 3 4 5 6 or more

Did the children witness (heard or saw) any abuse on you from your partner? yes no

If so, what sort of abuse? (please give details, eg physical assault, shouting, sexual assault, etc)

Where the children abused by your partner? yes no

If so, what sort of abuse did your children suffer? (space for comments)

Have you ever been injured as a result of trying to protect your children? yes no

If you are seperated from your abusive partner, do your children still have contact with him/her? no yes but infreqently yes, regularly (weekly) abuser has custody

General Questions for ALL abuse types

What is/was your relationship to the abuser at the time of the abuse?

if family member or other, please specify

Is your abuser male or female?

Are you still living with or in close contact with your abuser?

yes no sometimes

How long have you been/were you in an abusive relationship?

How long had/have you been in an abusive relationship before confiding in someone?

About Support available

If you are still in an abusive relationship, have you confided in anyone?

yes no

if yes, whom have you told about the abuse?

Both current victims and survivors:

Of the following, how would you rate the help and support you have received?

How long had the abuse been ongoing before you contacted an official body (eg Police, Refuge, Social Services)?

About Hidden Hurt

How did you come across Hidden Hurt? search engine link from other DV site recommended by a friend newspaper etc

How do you rate the information on Hidden Hurt?

Are there any topics which you feel have not been adequately covered in Hidden Hurt, or any other issues you would like to see on Hidden Hurt?

If you are happy for us to quote some of your experiences on Hidden Hurt, please tick this box.

Any other comments?

Please remember:
We cannot answer any questions included in this form.
If you wish to contact someone, please send an email (see Contact Page)

Thank you for taking the time to fill in the questionnaire. Your feedback is appreciated!