Self Harm Survey

1. How old were you when you started self-harming?
[] Younger than 4

[] 4-5 

[] 6-7

[] 8-9

[] 10-11 

[X] 12-11

[] 14-15

[] 15-16

[] 16-17

[] 18-19

[] 20-21

[] Older than 21

2. How often do you self-harm?

[] Depending on what mood I’ve been in

[] More than once a day

[] Once a day(usually)

[] Several times a week

[] Once a week

[] Two or more times a month

[] Once a month

[] Several times in a year

[] Once a year

[] I have stopped

[x] I am trying to stop

3. What method of self-harm do/did you use?

[x] Cutting

[x] Burning

[x] Hair-pulling

[x] Scratching

[x] Interference with the healing of wounds

[x] Hitting or bruising

[] Bone breaking

[x] Hitting Head against walls

[] Binging

[] Purging

[x] Starving

[] Biting
[x] rubber band slaps

[x] burning with hot water

4. If You Self Harm What Sexual Orientation Are You?

[] Straight Male

[X] Straight Female

[] Bi-Sexual Male

[] Bi-Sexual Female

[] A-sexual female

[] A-sexual male

[] Homosexual Male

[] Homosexual Female

[] Transgender Male
[] Transgender Female

[] Questioning Male

[] Questioning Female

[] Pan-sexual Male

[] Pan-Sexual Female 

[] Prefer not to answer

[] Demisexual Female

5. Which Of These, If Any, Are Something You Struggle With Along With Self-harm?

[] Anorexia

[] Bulimia

[] Anorexia and Bulimia

[x] EDNOS

[X] Suicidal

[X] Various Psychiatric Disorders (i.e. Bi-polar,Borderline Personality, OCD, Panic, Anxiety, PTSD, Dissociative, Impulse Control Etc.)

[] Learning Disabilities

[]None of the Above ~Not Diagnosed with anything~

6. Do You Think That You (as An Individual) Need Professional Help To Stop Self-harming?

[] Yes, The Only Way I Could Stop Is With Professional Help

[] No, I Have Stopped On My Own

[] No, I Have Stopped On My Own Though I Still Struggle Often And Sometimes Mess Up

[] I Have No Desire To Stop And Therefore Don’t Need Professional Help

[] Yes, I Have Stopped With Professional Help

[] I don’t think I could ever stop without Professional help

[] Prefer not to answer

[] I don’t know
[x] No

7. Are You Trying To Stop Self Harming?

[] No, And I Don’t Want To Stop.

[] No, But I Would Like To Be Able To Stop

[] Yes, But I Am Not Doing Very Well

[x] I Have Stopped But I Still Mess Up Every Once In A While

[] I Am Completely Self Harm free

[] Yes, but I don’t want to

8. Does Anyone Know About Your Self Harm?

[] No. No One Knows

[] Some People May Have A Vague Idea Of Something

[] Yes, But Only My Closest Friend (s)

[] Yes. But Only Some Of My Family Member(s)

[x] Yes, Some Friend(s) And Family Member(s) Know

[]Yes, All (or Most Of) My Friends Know

[]Yes, All (or Most Of) My Family Know

[x] Yes, People that see my scars/cuts

[] Just a couple of people I trust

[] Yes, My Therapist, Psychiatrist, etc

9. How many years have you been self-harming?

[]1 or less years

[] 2 years

[x] 3 years

[] 4 years

[] 5 years

[] 6 years

[] 7 years

[] 8 years

[]9 years

[] 10 or more years

10. If You Self-harm, Were You Abused Or Neglected (either As A Child Or Later In Life)?

[] No
[] Yes, I Was Emotionally Abused

[] Yes, I Was Physically Abused

[] Yes, I Was Sexually Abused

[] Yes, I Was Emotionally And Physically Abused

[] Yes, I Was Physically And Sexually Abused

[] Yes, I Was Sexually And Emotionally Abused

[x] Yes, I Was Emotionally, Physically And Sexually Abused

[]Yes, I Was Neglected

[] Yes, I Was Neglected As Well As Being Abused

[] Prefer not to answer

11. Would you label yourself as emo?

[] Yes

[x] No

[] I guess..?

12. Do others label you as emo?

[] Yes

[] No

[X] Some People

[] I don’t know

13.What would you or others label you as? (chose all that apply) Please select all that apply.

[] Prep
[] Goth

[] Emo

[] Punk
[] Nerd

[] Hipster

[] Pothead

[] Poser

[] Skater

[] Druggie
[x] Freak

[] Normal

[] I dont know

[] I don’t believe in labels

14. What is your reaction when you see other people’s self-harm scars/cuts/marks? (choose all that apply)

[x] I want to get to know them

[x] I wonder what they went through to feel that was a way out

[] I want to get as far as possible from them so no one will find out about my own self-harm

[X] I will acknowledge them as someone who shares something in common with me

[] I would never even acknowledge them

[x] What happened for them to start cutting

[] Fear

[X] Interest

[x] Sadness

[] Happiness

[] Don’t really care

[] No reaction

[x] Surprise

[] Relief

[] Jealousy

[] Upset that nobody else cuts as bad as me

[] Happy that nobody else cuts as bad as me

Honestly…

brookenbonesandscaredskin:

There is nothing like cutting your arm. You can cut everywhere else but there is something about cutting your arm/wrist that just feels immensely better.

I wish I had friends… someone to text and tell anything and when I’m having a bad day in school they let me talk to them and spill anything to them. 

Why do I keep disappearing? Sorry guys hopefully I’m back for good.

Anyone miss me?

No? I didn’t think so…

I’m back… I suppose.