Emotional Abuse Questionnaire


An emotional abuse questionnaire is one that aims at testing whether an individual is undergoing such a predicament. The questions assist the counselor to determine the level of abuse and the reasons behind the abuse.

An emotional abuse questionnaire also helps in revealing the extent of the damage caused psychologically to the patient. With the help of the questionnaire the doctor or counselor can trace the source of the abuse.

An emotional abuse questionnaire helps the doctor or counselor to prescribe proper medication or take necessary action to treat the patient. The subtle approach of the questionnaire also helps the patient to share information he hasn’t shared before.

Sample Emotional Abuse Questionnaire


  1. Does your partner/colleagues/friends try to trap you to do things to show that you are not a good person?_________________________________________________________
  2. Has anyone soiled your name among friends /colleagues or relatives by saying negative things about you?_______________________________________________________
  3. Does anyone tell other people that you don’t behave normally and that your character is suspicious?_____________________________________________________________
  4. Has anyone said physically abusive things to you, e.g. you are ugly? Or you are not smart?_____________________________________________________________
  5. Do people insult your religious inclination by saying bad things about your religion?_________________________________________________________
  6. Do people discriminate you because of your ethnic background? If so, how._________________________________________________
  7. Does anyone have a tendency of humiliating you in front of other people?_______________________________________________
  8. Have you given personal information to someone who disclosed it to other people?____________________________________________
  9. Have you ever been to a hospital or an institution as a result of emotional problem?________________________________________________
  10. Has anyone ever complained about conduct being abnormal?_______________________________________________________
  11. Have you taken any medication for emotional purposes? ______________________________________________

Category: Health Questionnaire

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