How old were you when you started self-harming?
- Younger than 4
- Older than 21
2 How often do you self-harm
- More than once a day
- Once a day
- 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
- I am trying to stop
3 What methods of self-harm do you use?
- Interference with the healing of wounds
- Hitting or bruising
- Bone breaking
- Cutting and Scratching
- Cutting and Burning
- Hitting Head against walls
- Purging sometimes.. rarely.
- Snapping rubberbands to onself
4 If You Self Harm What Sexual Orientation Are You?
- Straight Male
- Straight Female
- Bi-Sexual Male
- Bi-Sexual Female
- Homosexual Male
- Homosexual Female
- Transgender Male
- Transgender Female
- Questioning Male
- Questioning Female
- Pan-sexual Male
- Pan-Sexual Female
- Prefer not to answer
5 Which Of These, If Any, Are Something You Struggle With Along With Self-harm?
- Anorexia and Bulimia
- Suicidal Ideation
- Various Psychiatric Disorders (i.e. Bi-polar, Borderline Personality,OCD, Panic, Anxiety, PTSD, Dissociative, Impulse Control Etc.)
- Learning Disabilities
- A Mixture of the Above
- None of the Above
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 Often 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 with or without Professional help
- prefer not to answer
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.
- I Have Stopped But I Still Mess Up Every Once In A While.
- I Am Completely Self-harm free
8 Does Anyone Know About Your Self Harm?
- No. No One Knows. (perhaps Exluding online Friends)
- Some People May Have A Vague Idea Of Something
- Yes, But Only My Closest Friends
- Yes. But Only Some Of My Family Member(s)
- Yes, Some Friend(s) And Family Member(s) Know
- Yes, All (or Most Of) My Friends Know
- Yes, All (or Most Of) My Family Knows
- Yes, Most Of The People In My Life Know
9 How many years have you been self-harming?
- 1 or less years
- 2 years
- 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)?
- 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
- Yes, I Was Emotionally, Physically And Sexually Abused
- Yes, I Was Neglected
- Yes, I Was Neglected As Well As Being Abused
- i have no idea, i dont know what normal is , or if i have normal.
11 Would you label yourself as emo?
12 Do others label you as emo?
13 What would others label you as? (chose all that apply)
- I don’t do labels
- There aren’t really any labels above that fit me
14 What is your reaction when you see other people’s self-harm scars/cuts/marks? (choose all that apply)
Please select all that apply.
- I want to get to know them
- 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
- I will acknowledge them as someone who shares something in common with me
- I would never even acknowledge them
- Don’t really care
- No reaction