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2011
November
T
The effects of child abuse on healthy adult relati
The effects of child abuse on healthy adult relati
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What is your current age?
18-25 years
26-35 years
36-45 years
46+ years
Are you
Single
In a committed relationship
Engaged
Married
Separated
Divorced
Widowed
How old were you when you were sexually abused as a child or when the abuse began
Under the age of 5 years
6-10 years
11-15 years
16-18 years
How many times did the abuse occur?
Once
Between 2-5 times
Between 6-10 times
Over 10 times
I can't remember
The person who sexually abused you was
Stranger
Babysitter
Neighbor
Family Friend
Teacher
Mother
Father
Grandmother
Grandfather
Stepmother
Stepfather
Brother
Sister
Aunt
Uncle
Cousin
Someone else
How old were you when the sexual abuse stopped?
Under the age of 5
6-10 years
11-15 years
16-18 years
Did you ever talk to anyone about the abuse as a child?
Yes, I was helped
Yes, but I was not believed
Yes, but nothing changed
No I did not tell anyone
Do you still keep in contact with the person who sexually abused you as a child?
Yes
No
Do you believe that you have difficulties trusting others?
Yes
No
I don't know
Have you ever cheated on your significant other?
Yes
No
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