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 Abuse & Neglect Scoring Sheet 

Analyze on a ten-point scale the amount and degree of abuse in each category. The descriptions of the different areas of abuse are provided for you review while determining your score. Please chooses a score for each area.

  • 1 or 2 - means little or no abuse has occurred in this category.
  • 3 or 4 - means some abuse has occurred in this category.
  • 5 or 6 - means a moderate amount of abuse has occurred for this category.
  • 7 or 9 - means a severe amount of abuse has occurred for this category.
  • 10      - means the abuse that has occurred in this category is extreme.

Any score five or above for a particular category needs to be further identified, clarified, and explained.

Abuse and Neglect Score Sheet 

Choose the appropriate number, or score, for each category below.

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Physical Abuse
Physical abuse can best be understood as the physical deprivation either by design or default of a person's primary needs for survival. Such needs include but are not limited to food water clothing shelter and safety. Individuals raised in either low social economic conditions such as poverty or in a dangerous environment such as in a war torn country are most likely to be victims of physical abuse.
If your Physical Abuse Score is more than 5 please explain.
 
Mental Abuse
Mental abuse is best understood as the control or manipulation of a person's mind through threats or intimidation using power or authority to create fear or terror through the perception of the possibility of impending doom if the person misusing the power is not obeyed.
If your Mental Abuse Score is more than 5 please explain.
 
Emotional Abuse
Emotional abuse is the misuse of language to hurt criticize or offend. It is verbally using the tongue to "tongue lash" and create emotional scaring through belittling teasing sarcasm or outright hostility and contempt. It creates a significant impact on the person's self-worth self-esteem and self-image.
If your Emotional Abuse Score is more than 5 please explain.
 
Experiential Abuse
Experiential abuse is the neglect or lack of significant and meaningful experiences through the critical relationships in a person's life necessary to establish the sense of self-worth through the fact I mean enough to someone that they will invest time to be with me. The loss of these either through default or design leaves a person without the necessary memories and experiences to draw upon for the wisdom of life.
If your Experiential Abuse Score is more than 5 please explain.
 
Spiritual Abuse
Spiritual abuse is the misuse of God given authority to influence a person away from a healthy relationship with God. This can take three forms. Intentional misleading as in involving the person in inappropriate or wrong cult-like experiences using God or the fear of God to punish or intimidate or sexually abusing the individual so as to distort their emerging self-identity are the three forms. This affects a person's ability to relate to God as a loving God
If your Spiritual Abuse Score is more than 5 please explain.
 
Relational Abuse
Relational abuse is the misuse of power in a relationship to create or cause deliberate bodily harm. This harm results in the loss of trust by the victim of future relationships due to the ability of others to inflict or cause bodily harm or pain.
If your Relational Abuse Score is more than 5 please explain.
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Christian Counseling Centers of Indiana
Two Locations:
Avalon Christian Counseling Center - Fort Wayne, Indiana
Auburn Christian Counseling Center - Auburn, Indiana