Intimate Partner Violence
Intimate partner violence (IPV) is a pattern of abusive and coercive behavior that may include
physical, emotional, sexual and psychological, reproductive abuses as well as progressive social
isolation, stalking, deprivation and intimidation. These behaviors are perpetrated by someone
who is, was or wished to be involved in an intimate or dating relationship with an adult or
adolescent, aiming to gain control of one partner over the other. It can be experienced by same or
opposite sex relationships in both men and women regardless of age, status, nationality, color or
creed. This survey is for solely for research analysis. Surveyors are urged not to make personal
inscriptions on the sheet to ensure confidentiality of each participant. Finally, please read and
answer the questions as accurate and truthful a possible.
Section A-Demographic
Gender: □ Male □ Female
Age: □16-25 □26-35 □36-45 □46-55 □56-65 □66+
Matriculation Status: □Part-time Student □Full Time Student
Section B
1. Prior to reading information regarding the survey, were you aware of Intimate Partner
Violence (IPV)? □ Yes □ No
2. Have you ever experienced emotional, sexual, physical or verbal abuse from a partner or
spouse? □ Yes □ No
3. Are you currently in a relationship or dating someone? □ Yes □ No
4. If yes, do you ever feel frightened by what your partner says or does? □ Yes □ No
5. Do arguments result in you feeling down or bad about yourself? □ Yes □ No
6. Do arguments ever result in hitting, kicking or pushing? □ Yes □ No
7. Are you afraid of voicing a different opinion than your partner? □ Yes □ No
8. Have you ever been abused by a partner or someone close to you? □ Yes □ No
9. Do you feel anxious or nervous around your partner? □ Yes □ No
10. Do you watch what you do or say in order to avoid making your partner angry or upset?
□ Yes □ No
11. Do you feel obligated or coerces in to sexual intercourse with your partner? □Yes □ No
12. Does your partner criticize or embarrass you in front of other? □ Yes □ No
13. Does your partner prevent you from seeing family or friends? □ Yes □ No
14. Does your partner tell you that they will stop beating you when you behave? □ Yes □
No
15. Is there always an excuse for your partner’s behavior? (eg. I was drunk!) □ Yes □ No
Section C
Statement Strongly Agre Neutral Disagree Strongly
Agree e Disagree
1.Intimate partner violence can be avoided
2.IPV is solely the victims fault.
3.Violence should be condoned in any
situation
4.IPV is a serious health problem.
5.Claims of IPV should be taken seriously
6.Perpetrators of IPV should be punished.
7.IPV should be accepted based on the
circumstance
8.IPV is a an important aspect of a couples
relationship
9.Victims of IPV should remain with abuser
at all times.
10.Accepting gifts and apologies from a
perpetrator is the best thing to do.
11.A victim of IPV should get away and seek
help quickly.
12.IPV should reported as soon as it
happens.