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Following are a number of statements that women have used to describe their lives with their male partners. Please read each statement, then circle the answer that best describes how much you agree or disagree in general with each one as a description of your relationship. If you are not now in a relationship think about the last man you were involved with. There are no right or wrong answers: just circle the number that seems to best describe how much you agree or disagree with each statement.

1. He makes me feel unsafe even in my own home.
2. I feel ashamed of the things he does to me.
3. I try not to rock the boat because I am afraid of what he might do.
4. I feel like I am programmed to react a certain way to him.
5. I feel like he keeps me prisoner.
6. He makes me feel like I have no control over my life, no power, no protection.
7. I hide the truth from others because I am afraid not to.
8. I feel owned and controlled by him.
9. He can scare me without laying a hand on me.
10. He has a look that goes straight through me and terrifies me.

Response Options:
Disagree strongly - 1
Disagree somewhat - 2
Disagree a little - 3
Agree a little - 4
Agree somewhat - 5
Agree strongly - 6