FACSAFoundation.org Shattering The Silence Tour Documentary Project February 2015 Volume 3 | Page 102
32) My partner and I make love more than three times a week. Circle One
Strongly
Agree
Doesn’t
Disagree Strongly
Agree
Disagree
Apply
33) When angry, I become. Circle All That Apply
Withdrawn
&
Hostile
Verbally
Self-Destructive
34) My anger last for
5 minutes
Abusive
Calm Down
Abusive
Talk Through Problem
Circle One
20 minutes
Hold a grudge forever
35) My partner’s anger last for
5 minutes
Physically
all day
until I get even
Circle One
20 minutes
Hold a grudge forever
an hour
an hour
all day
until I get even
36) I deal with problems by Circle All That Apply
Talking the problem through
Sleeping
Ignoring problems
Walking away
Drinking
Taking Drugs
Blaming problems on someone else
37) During busy days, I find myself needing to withdraw into bed, into a darkened room or any
place where I can have some privacy and relief from stimulation. Circle One.
Strongly
Agree
Disagree Strongly
Doesn’t