Emotional Toxicity Questionnaire continued
PART 2 - Adverse Childhood Events (ACEs)
While you were growing up, during your first 18 years of life:
30. Did a parent or other adult in the household often swear at you, insult you, put you down, or humiliate you? Or act in a way that made you afraid that you might be physically hurt?
31. Did a parent or other adult in the household often push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?
32. Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way? Or try to or actually have oral, anal, or vaginal sex with you?
33. Did you often feel that nobody in your family loved you or thought you were important or special? Or your family didn’t look out for each other, feel close to each other, or support each other?
34. Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, had nobody to protect you? Or your parents were too drunk or high to take care of you?
35. Have you ever felt abandoned or not cared for?
36. Were your parents ever separated or divorced?
37. Did you witness violence? Was your parent, sibling, or other family member often pushed, grabbed, slapped, or had something thrown at them? Or at any time kicked, bitten, hit with a fist, or hit with something hard? Or ever repeatedly hit, or threatened with a gun or knife?
38. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
39. Was a household member depressed, or mentally ill, or did a household member attempt suicide? Or were there any deaths in the family?
40. Did a household member go to prison?
41. To you knowledge, did either of your care givers experience emotional trauma, e.g. Holocaust, natural disasters, bullying, homelessness, etc.? Or was your birth traumatic?
42. Were you ever teased, bullied, or shunned by your peers or teachers?
43. Did you experience racism, homophobia or similar forms of abuse?
44. Did you experience a serious physical trauma, illness or accident as a child which required hospitalization?
45. Were you or was anyone close to you homeless when you were young?
46. Did anyone close to you die? Did you experience death or see dead bodies?
47. Did your family experience significant financial difficulties during your childhood resulting in e.g. loss of job or home?
48. Did you feel you didn't really have friends and didn't really feel close to anyone?
