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
- 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
- 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
- Burning
- Hair-pulling
- Scratching
- Interference with the healing of wounds
- Hitting or bruising
- Bone breaking
- Cutting and Scratching
- Cutting and Burning
- Hitting Head against walls
- Binging
- Purging
- Starving
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
- Bulimia
- 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 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
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.
- 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 (on and off)
- 9 years
- 10 or more years (since I first did it)
10 If You Self-harm, Were You Abused Or Neglected (either As A Child Or Later In Life)?
- No
- Yes, I Was Emotionally Abused
- Yes, I Was Physically Abused
- Yes, I Was Sexually Abused (I was raped once)
- 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 Would you label yourself as emo?
- Yes
- No
12 Do others label you as emo?
- Yes
- No
- Some people
13 What would you or others label you as? (chose all that apply)
Please select all that apply. (I’ve been labeled these by others)
- Prep
- Goth
- Emo
- Punk
- Nerd
- Hipster
- Poser
- Skater
- Jock
- Scene
- 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)
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
- Fear
- Interest
- Sadness
- Happiness
- Don’t really care
- No reaction
- Surprise
- Relief
- Jealousy
And the truth comes out
Eating Disorder Survey
So this is me, but answer it yourself. It helps you analyze yourself. BE HONEST WITH YOURSELF.
Ever hurt yourself on purpose? –Yes
Ever been to a psychologist? – yes
Lost weight? - yes
Gained weight? - yes
Do you drink? – socially
Do you smoke? - occasionally
Do you take drugs? - no
Does your weight affect your mood? – sometimes/rarely.
Do you weigh yourself daily? – not allowed to own a scale
Have you ever gone through a whole day without food (fast)? - yes
Have you ever skipped a meal? - yes
Have you ever spit food out? – no
HABITS:
[x] I keep my eating habits a secret
[used to] I look at thinspo
[used to] I collect thinspo
[used to] I count calories
[x] I avoid food
[x] I hate food
[x] I love food
[ ] I purge if I think I ate too much
I AM:
[x] anorexic
[] ednos
[] bulimic
[] living off diet pills
[x] hungry
[] thirsty
[] drinking something
[x] Under 100lbs
[x] fasting/starving myself
PEOPLE:
[] ask if I’m anorexic/bulimic/have an ED
[] have called me fat
[x] have said I’m skinny
[x] have said I’m ugly
[x] have said I’m pretty
[x] spread rumors about me
[x] forced me to eat
I WISH:
[] I was thin
[x] I had a better body
[x] I didn’t have to eat
[x] I could control myself
[] I was under 100 lbs
[x] I could avoid food
[x] I could hide what I am
[] I wasn’t fat
[x] I was pretty
[x] I could stop being anorexic/bulimic/ednos
I LOVE:
[x] feeling hungry
[] seeing a difference when fasting
[] shaking
[] feeling airy
[x] losing weight
[] being anorexic/bulimic/ednos
[x] green tea
[] diet pills
[x] being able to turn down food
[x] feeling good about myself
APPEARANCE:
[x] I am shorter than 5’4
[x] I think I’m ugly
[x] I have self made scars
[] I have a tattoo
[x] I wear glasses
[x] I’ve been told I’m attractive by a complete stranger
[] I have more than 2 piercings
[] I have piercings in places besides my ears
[] I have freckles
[A] Cup size is (A) (B) (C) (D)
[] I am pear shaped
[x] I am petite
[hourglass] I am apple/hourglass shaped
BRITISHLY PREP HUGE GIVEAWAY!!
giveaway includes:
- 1 pair of Tory Burch flats
- 1 Burberry scarf
- 1 j.crew socks
- 1 kate spade glasses
- 1 ray band sunglasses
- 2 kate spade braclets
- 1 vinyard vines belt
- 1 ipad
I don’t need this/ don’t use it anymore so I’m giving it away!!
RULES!!
reblog as many times as you want to increase your chances
no likes
MUST BE FOLLOWING ME BRITISHLYPREP I CHECK!!!
choosing the winner April 15th
Get rebloging!
UGH!
I hate admitting I have a crush on anyone, because as soon as I admit it to myself, I go into that weird crush mode where I start acting weird around that person. Like I over-analyze everything, esp. my own actions/words/gestures. Why do I do this to myself? Isn’t this why I choose to pick my crushes from now on? Oh if only life worked that way.
BRITISHLY PREP HUGE GIVEAWAY!!
giveaway includes:
- 1 pair of Tory Burch flats
- 1 Burberry scarf
- 1 j.crew socks
- 1 kate spade glasses
- 1 ray band sunglasses
- 2 kate spade braclets
- 1 vinyard vines belt
- 1 ipad
I don’t need this/ don’t use it anymore so I’m giving it away!!
RULES!!
reblog as many times as you want to increase your chances
no likes
MUST BE FOLLOWING ME BRITISHLYPREP I CHECK!!!
choosing the winner April 15th
Get rebloging!
