Self Harm Survey
1 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 method of self-harm do/did you primarily use?
Interference with the healing of wounds
Hitting or bruising
Cutting and Scratching
Cutting and Burning
Hitting Head against walls
4. If You Self Harm What Sexual Orientation Are You?
Prefer not to answer
5 Which Of These, If Any, Are Something You Struggle With Along With Self-harm?
Anorexia and Bulimia
Various Psychiatric Disorders
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 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 with or without Professional help
Prefer not to answer
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.
Some People May Have A Vague Idea Of Something
Yes, But Only My Closest Friends(s)
Yes. But Only Some Of My Family Member(s)
Yes, Some Friend(s) And Family Member(s) Know that I used to.
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
Who ever sees this post
9 How many years have/had you been self-harming?
1 or less 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
11. Were you ever bullied?
Yes, since before I was 8. I am still bullied.
Yes, since before I was 8. It has stopped since then.
Yes, starting when I was 9 or 10. I am still bullied.
Yes, starting when I was 9 or 10. It has stopped since then.
Yes. It started when I was 11-14 years old. I am still bullied.
Yes. It started when I was 11-14 years old.
Yes. It started when I was older than 14. I am still bullied.
Yes. It started when I was older than 14. It has stopped since then.
No. I do taunt, tease, exclude, target, or mock others on occasion, however.
No. I see others getting bullied and don’t do anything.
No. I don’t get bullied and I stand up for those who do.
No. I never see bullying.
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)
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)
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