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?
 Depending on what mood I’ve been in…
 More than once a day
 Once a day(usually)
 Several times a week
[x] 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 primarily use?
[x] Interference with the healing of wounds
[x] Hitting or bruising
 Bone breaking
 Hitting Head against walls
 rubber band slaps
 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 (FAAB, Agender)
 Prefer not to answer
 Demisexual Female
5. Which Of These, If Any, Are Something You Struggle With Along With Self-harm?
[x] Anorexia and Bulimia
[x] Various Psychiatric Disorders (i.e. Bi-polar,Borderline Personality, OCD, Panic, Anxiety, PTSD, Dissociative, Impulse Control Etc.)
[x] 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 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
[x] I don’t know
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
[x] 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
 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
 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 year
 2 years
 3 years
 4 years
 5 years
 6 years
 7 years
 8 years
[x] 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
[x] 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
 Not sure how to answer
11. Would you label yourself as emo?
 I guess..?
12. Do others label you as emo?
 Some People
 I don’t know
13. What would others label you as? (choose all that apply) Please select all that apply.
 I don’t know
[x] 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)
 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
15. What were you feeling when you started self-harming?
 Don’t really care
 No reaction