Item number | Description |
---|---|
1: Life-threatening disease | Have you ever had a life-threatening illness/disease? |
2: Accident | Were you ever in a life-threatening accident? |
3: Physical assault | Was physical force or a weapon ever used against you in a robbery or assault? |
4: Bereavement | Has an immediate family member, romantic partner or very close friend died as a result of accident, homicide, or suicide? |
5: Rape | Has anyone (parent, other family member, romantic partner, stranger, or someone else) ever forced or threatened you into having intercourse, oral, or anal sex against your will, or when you were in some way helpless? |
6: Other sexual assault | Other than experiences you have already described, has anyone ever touched your genitals or made you touch theirs against your wishes, or when you were in some way helpless? |
7: Childhood physical abuse | When you were a child, did a parent, caregiver or other person ever kick you repeatedly, beat or otherwise attack or harm you? |
8: Adulthood physical abuse | As an adult (> 18 years), have you ever been kicked, beaten, slapped around or otherwise physically harmed by a romantic partner, date, sibling, family member, stranger, or someone else? |
9: Emotional abuse | Has a parent or a romantic partner systematically ridiculed you, humiliated you, or called you worthless? |
10: Threatened | Other than the experiences already covered, has anyone ever threatened you with a weapon, like a knife or gun? |
11: Witnessed a traumatic event | Have you ever witnessed another person being killed, seriously injured, or sexually or physically assaulted? |
12: Other | Other than the events you have already described, have you ever been in any other situations that was extremely frightening or horrifying, or where you felt very helpless? |