Professional Documents
Culture Documents
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TO INTERVIEWER: Record the recent event(s) that comprised the victimisation. Include
information regarding the perpetrator, what happened, when and where the event(s) took place, and
any other circumstantial information deemed important.
Prior to presenting this questionnaire, read the following instructions to the child:
“I am going to ask you several questions about what happened between you and (perpetrator). I am
NOT going to ask you to describe what happened, instead, I want to know YOUR thoughts and
feelings about what happened. I will read a sentence and you can tell me whether or not it is very
true, somewhat true, or not true. There are no right or wrong answers to the questions I will be
asking. Some of the questions may cause you to remember things that were unpleasant. If you feel
very uncomfortable answering any question, let me know, and I can move on to another question.”
SCALES:
PTSD Attributions about abuse
IT Intrusive Thoughts SB-GU Self Blame/Guilt
AV Avoidance PV Personal Vulnerability
HYP-AR Hyperarousal DW Dangerous World
SX-A Sexual Anxiety EMP Empowerment
6. I often feel irritable for no reason at all. ________ ________ ________ (Hyp-AR)
9. If adults bother me, I can stop them. ________ ________ ________ (EMP)
10. These kinds of things happen often. ________ ________ ________ (PV)
16. I was to blame for what happened. ________ ________ ________ (SB-GU)
17. People often take advantage of children. ________ ________ ________ (DW)
21. I was not to blame for what happened. ________ ________ ________ (SB-GU)
(reverse)
22. This happened to me because I acted in a
way that caused it to happen. ________ ________ ________ (SB-GU)
25. Things in my life will get better. ________ ________ ________ (EMP)
28. I feel I have caused trouble to my family. ________ ________ ________ (SB-GU)
32. I try not to think about what happened. ________ ________ ________ (AV)
40. I feel guilty about what happened. ________ ________ ________ (SB-GU)
41. Thinking about sex upsets me. ________ ________ ________ (SX-A)
44. I get frightened when I think about sex. ________ ________ ________ (SX-A)
55. People who I trusted let me down. ________ ________ ________ (NRO)
57. I feel I should be punished for what I did. ________ ________ ________ (SB-GU)
75. I wish there was no such thing as sex. ________ ________ ________ (SX-A)
78. Bad things happen to be all the time. ________ ________ ________ (PV)