Survey

Self Harm Survey

1 How old were you when you started self-harming?

Younger than 4

4-5

6-7

8-9

10-11

12-13

14-15(check)

15-16

16-17

18-19

20-21

Older than 21

2 How often do you self-harm

More than once a day

Once a day

Several times a week(check)

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?

Cutting(check)

Burning

Hair-pulling

Scratching

Interference with the healing of wounds(check)

Hitting or bruising

Bone breaking

Cutting and Scratching

Cutting and Burning

Hitting Head against walls

Binging

Purging

Starving

Other

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

Straight Male

Straight Female

Bisexual Male(check)

Bisexual Female

Homosexual Male

Homosexual Female

Transgender Male

Transgender Female

Questioning Male

Questioning Female

Pansexual Male

Pansexual Female

Prefer not to answer

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

Anorexia

Bulimia

Anorexia and Bulimia

EDNOS

Suicidal Ideas(check)

Various Psychiatric Disorders

Learning Disabilities

None of the Above

Other

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(check)

Yes, I Have Stopped With Professional Help

I don’t think I could ever stop with or without Professional help

Prefer not to answer

Not sure.

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(check)

Yes, But Only My Closest Friends(s)(check)

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(check)

9 How many years have/had you been self-harming?

1 or less years(check)

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)?

No(check)

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.(check)

No. I never see bullying.

Other.

11 Would you label yourself as emo?

Yes(check)

No

12 Do others label you as emo?

Yes(check)

No

Some people

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

Prep

Goth

Emo(check)

Punk(check)

Nerd

Hipster

Poser

Skater

Jock

Scene(check)

Gangster

Other

I don’t do labels

There aren’t really any labels above that fit me

Normal

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(check)

I wonder what they went through to feel that was a way out(check)

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(check)

I would never even acknowledge them

Fear

Interest(check)

Sadness(check)

Happiness

Don’t really care

No reaction

Surprise

Relief

Jealousy
dreambigwh11 dreambigwh11
13-15, M
Dec 11, 2012