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Q.1
Were you physically or emotionally abused as a child or did you witness a family member abuse people and animals, either verbally or physically?
*
Very Often
Often
Sometimes
Rarely
Never
I don't know
Q.2
Do you have a history of other mental health conditions, such as antisocial personality disorder, borderline personality disorder, mood disorder, anxiety, or substance abuse?
*
Yes
No
I don't know
Q.3
Do you anger quickly and for relatively inconsequential reasons? For example, would you become enraged if dinner were not cooked the way you liked it, if one of your children spilled something, or if a task were not completed to your liking?
*
Very Often
Often
Sometimes
Rarely
Never
Q.4
Have you paid fines or been arrested for crimes involving anger, such as domestic violence, physical altercations, verbal threats, or road rage?
*
Very Often
Often
Sometimes
Rarely
Never
Q.5
Do you have an overall feeling of irritability and find it difficult to relate to other people because you are easily annoyed at their behaviors or opinions?
*
Very Often
Often
Sometimes
Rarely
Never
Q.6
Are your anger episodes extremely intense, but over in about 30 minutes? Once your anger has subsided, do you feel tired and embarrassed about your behavior?
*
Very Often
Often
Sometimes
Rarely
Never
Q.7
Have you lost several jobs, mostly for your irritable attitude? Do you become argumentative with coworkers and have a difficult time taking direction from superiors? Have you yelled and cursed at your boss or coworkers?
Very Often
Often
Sometimes
Rarely
Never
Q.8
Do certain situations, such as being told what to do or being publicly corrected for your language or behavior, make you particularly angry? Are you similarly triggered when you perceive that someone has treated you unfairly or that you did not get what you wanted?
*
Very Frequently
Often
Sometimes
Not Often
Never
Q.9
During a violent episode, might you scream, kick, push, shove or punch others? Do you show your anger by destroying property, throwing and breaking items, punching holes in walls, or kicking in doors?
*
Very Often
Often
Sometimes
Rarely
Never
Q.10
Have you been accused of cruelty to animals? Have you kicked or hit your pets for minor infractions, such as urinating on the carpet or jumping on the furniture?
*
Very Often
Often
Sometimes
Rarely
Never
Q.11
When an episode begins, do you lose the ability to think about the consequences of your actions? Does it feel as if you have no control over your thoughts and react without thinking?
*
Very Often
Often
Rarely
Not Often
Never
Q.12
When an episode has ended, do you feel great remorse and regret? Do you promise to never behave in that way again? But then, when the anger builds again, do you feel you are unable to control it?
*
Very Often
Often
Sometimes
Rarely
Never
Q.13
Are your partner, children, and other family members afraid of you? Do they go to great lengths to not make you angry, knowing that even the smallest annoyance or frustration can bring on an episode?
*
Very Often
Often
Sometimes
Rarely
Never
Q.14
Do you use alcohol or other substances to help relieve the feelings of frustration or anger, but feel they don’t help — and may actually increase your feelings of anger and increase your violent or aggressive behavior?
*
Very Often
Often
Sometimes
Rarely
Never
Q.15
Have you considered suicide before or acted in ways that were harmful to yourself?
*
Very Often
Often
Sometimes
Rarely
Never
Q.16
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