How Difficult Was My Childhood? DIVORCE/SEPARATION OR ONE OR NO PARENTS Were your parents ever separated or divorced during your first 18 years of life or did you grow up with one or both of your biological parents absent? yes no PHYSICAL NEGLECT During your first 18 years of life did you sometimes 1) not have enough to eat, 2) not feel that there was someone there to take care of you and protect you, 3) think that your parents were too drunk or too high to take care of you, 4) have to wear dirty clothes or 5) not have someone there to take you to the doctor if you needed it. ? Yes No EMOTIONAL NEGLECT During your first 18 years of life did you often feel 1) there was no one in your family who helped you or made you feel important or special, 2) that you weren’t loved, 3) that people in your family didn’t look out for each other, 4) that people in your family didn’t feel close to each other, or 5) that your family was not a source of strength or support? Yes No MOTHER BEING MISTREATED During your first 18 years of life did your father, stepfather or mother’s boyfriend often push, grab, slap or throw something at your mother? Did they often kick, bite, hit her with a fist or hit her with something hard? Did they ever repeatedly hit her over at least a few minutes or 2) threaten her with a knife or gun, or use a knife or gun to hurt her? Yes No FAMILY EMOTIONAL PROBLEMS During your first 18 years of life, was anyone in your household depressed or mentally ill or did anyone in your household attempt to commit suicide? Yes No RECURRENT PHYSICAL ABUSE During your first 18 years of life, did adults sometimes push, grab, slap, or throw something at you or hit you so hard that you had marks or were injured? Yes No RECURRENT EMOTIONAL ABUSE During your first 18 years of life, did adults often swear at you, insult you, put you down, threaten to hit you or throw something at you? Yes No SEXUAL ABUSE During your first 18 years of life, did any adult or much older child ever 1) touch or fondle your body in a sexual way, 2) have you touch their body in a sexual way, 3) attempt to have any type of sexual intercourse with you (oral, anal or vaginal) or 4) actually have any type of sexual intercourse with you (oral, anal, or vaginal)? Yes No ALCOHOL OR SUBSTANCE ABUSE During your first 18 years of life, did you live with anyone who was a problem drinker, alcoholic, or who used street drugs? Yes No AN INCARCERATED HOUSEHOLD MEMBER During your first 18 years of life, did anyone in your household go to prison? Yes No