my current mentality is “im sad and i hate myself but i have to get good grades”
I am sad and I hate myself and I have bad grades
| 1/3 of me: | I wanna be fit and sexy and have a flat stomach and be lean and have lots of muscle. |
| 1/3 of me: | I wanna be skinny and tiny and dainty and delicate and bony and frail and look cute in everything. |
| 1/3 of me: | I wanna not give a shit about what I look like and be happy instead. |
I feel trapped in a tunnel. A dark, winding tunnel. Every once in a while I think I can see a glimmer of light - a way out. But it’s a cruel trick, and once again I am plunged into darkness.
1. How old were you when you started self-harming?
[] 8-9
[] 10-11
[x]12-13
[x] 14-15
[] 15-16
[] 16-17
[] 18-19
[] 20-21
[] 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
[x] 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
[x] I am trying to stop
3. What method of self-harm do/did you primarily use?
[x] Cutting
[] Burning
[] Hair-pulling
[x] Scratching
[x] Interference with the healing of wounds
[] Hitting or bruising
[] Bone breaking
[] Hitting Head against walls
[] Binging
[x] Purging
[x] Starving
[] Biting
[x] Rubber band slaps
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
[] Prefer not to answer
5. Which Of These, If Any, Are Something You Struggle With Along With Self-harm?
[] Anorexia
[] Bulimia
[] BDD (Body Dysmorphic Disorder)
[] Various Psychiatric Disorders (ADHD, OCD, Anxiety, Depression)
[x] 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
[x] I don’t think I could ever stop without Professional help
[] Prefer not to answer
[] 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
8. Does Anyone Know About Your Self Harm?
[] No. No One Knows
[] Some People May Have A Vague Idea Of Something
[x] Yes, But Only My Closest Friend(s)
[x] Yes. But Only Some Of My Family Member(s)
[] Yes, Some Friend(s) and Family
[] Yes, All (or Most Of) My Friends Know (I didn’t want them to)
[] Yes, All (or Most Of) My Family Know
[] Yes, People that see my scars/cuts
[x] Just a couple of people I trust
[] Yes, My Therapist, Psychiatrist, etc
9. How many years have you been self-harming?
[x] 1 or less years
[] 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)?
[x] No
[] Yes, I Was Emotionally Abused
[] Yes, I Was Physically Abused
[] Yes, I Was Sexually Abused
[] Yes, I Was Neglected
[] Prefer not to answer
11. Would you label yourself as emo?
[] Yes
[x] No
[] I guess..?
12. Do others label you as emo?
[] Yes
[] No
[] Some People
[x] I don’t know
13.What would others label you as? (chose all that apply) Please select all that apply.
[] Prep
[x] Goth
[x] Emo
[] Punk
[x] Nerd
[] Hipster
[] Pothead
[] Poser
[] Skater
[] Druggie
[x] Normal
[x] I don’t know
14. What is your reaction when you see other people’s self-harm scars/cuts/marks? (choose all that apply)
[x] 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
[] What happened for them to start cutting
[] Fear
[x] Interest
[x] Sadness
[] Happiness
[] Don’t really care
[] No reaction
[x] Surprise
[] Relief (that I wouldn’t have to hide my own from them)
[] Jealousy