Partner Emotional Maltreatment

The psychological symptoms caused or exacerbated by the incident or pattern of incidents (for example, depression, anxiety):

1. extremely impacted the overall level of functioning
2. highly impacted the overall level of functioning
3. somewhat impacted the overall level of functioning
4. did not impact the overall level of functioning.

The somatic symptoms caused or exacerbated by the incident or pattern of incidents (for example, aches and pains, migraine, gastrointestinal problems):

1. extremely impacted the overall level of functioning
2. highly impacted the overall level of functioning
3. somewhat impacted the overall level of functioning
4. did not impact the overall level of functioning.

Did avoidance of emotional abuse interfere with the ability to carry out any of these five major life activities?

• Work
• Education
• Freely participating in religious observance
• Obtaining necessary medical or mental health services
• Contact with family/friends

1. Yes
2. No

What was the level of interference of the fear?

1. Profound change in three or more of the following areas (work, education, freely participating in religious observance, obtaining necessary medical or mental health services, contact with family/friends)
2. Profound change in two of the following areas (work, education, freely participating in religious observance, obtaining necessary medical or mental health services, contact with family/friends)
3. Profound change in one of the following areas (work, education, freely participating in religious observance, obtaining necessary medical or mental health services, contact with family/friends)