1) How old were you when you started self-harming?
2) How often do you self-harm
Two or more times a month
3) What method of self-harm do/did you primarily use?
Interference with the healing of wounds
Hitting Head against walls
4) What Sexual Orientation Are You?
5) Which Of These, If Any, Are Something You Struggle With Along With Self-harm?
Various Psychiatric Disorders (i.e. Bi-polar, Borderline Personality, OCD, Panic, Anxiety, PTSD, Dissociative, Impulse Control Etc.)
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
es, I Have Stopped With Professional Help
I don’t think I could ever stop with or without Professional help
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?
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?
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 As Well As Being Abused
11) Would you label yourself as emo?
12) Do others label you as emo?
13) What would you or others label you as? (chose all that apply)
Please select all that apply.
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
Well it also depends on who it is, if it's my bestfriend. Sadness. For a stranger, intrest
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