Little things, explain the most

1. How old were you when you started self-harming?
Younger than 4 [ ]
4-5  [ ]
6-7  [ ]
8-9  [ x]
10-11  [ ]
12-13  [ ]
14-15  [ ]
15-16  [ ]
16-17  [ ]
18-19  [ ]
20-21  [ ]
Older than 2 2 [ ]

How often do you self-harm?
 [ x ] It really all depends
[ x] 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
 [ x ] Burning
 [ ] Hair-pulling
 [ x ] Scratching
 [ x ] Interference with the healing of wounds
 [ x ] Hitting or bruising 
[ ] Bone breaking 
[ x ] Cutting and scratching
 [ x ] Cutting and burning 
[ ] Hitting head against walls
 [ x] Binging 
[ x] Purging
 [ x ] Starving
 [ x ] Biting
 [ x ] Rubber band slaps 
[ ] Burning with hot water

 4. What Sexual Orientation Are You?
 [ ] Straight Male 
[ ] 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
 [ xxx] Pan-Sexual Female
 [ ] Prefer not to answer
 [ ] Demisexual Female

 5. Which Of These, If Any, Are Something You Struggle With Along With Self-harm?
 [ ] Anorexia
 [ ] Bulimia
 [ x] Anorexia and Bulimia
 [ ] EDNOS  (self diagnosed)
[ ] Suicidal
 [ x] Various Psychiatric Disorders (i.e. Bi-polar, Borderline Personality, OCD, Panic, Anxiety, PTSD, Dissociative, Impulse Control Etc.)
 [ ] 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
 [x ] 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  (I’ve gotten professional help and it didn’t so shit so fuck you ;-;)
[ ] 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.
 [ x] 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
 [ ] Yes, but I don’t want to

 8. Does Anyone Know About Your Self Harm? 
[ ] No. No one knows 
[ x] Some people may have a vague idea of something
 [ ] Yes, but only my closest friend(s) 
[ x] 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
 [ x] Yes, people that see my scars/cuts
 [ x] Just a couple of people I trust
 [ x] Yes, my therapist, psychiatrist, etc .

9. How many years have you been self-harming? 
[ ] 1 year 
[ ] 2 years
 [ ] 3 years (cutting)
 [ ] 4 years
 [ ] 5 years
 [ ] 6 years
 [ ] 7 years 
[ x] 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
 [ x] Yes, I was emotionally abused
 [ x] Yes, I was physically abused
 [x ] Yes, I was sexually abused
 [ x] Yes, I was emotionally and physically abused
[ x] Yes, I was physically and sexually abused
 [x ] Yes, I was sexually and emotionally abused
 [ x ] Yes, I was emotionally, physically and sexually abused 
[ ] Yes, I was neglected
 [ x ] Yes, I was neglected as well as being abused
 [ ] Prefer not to answer 

11. Would you label yourself as emo?
 [] Yes
 [ x ] No
 [ ] I guess..? 

12. Do others label you as emo?
 [ x] Yes
 [ ] No
 [ ] Some people
 [ ] I don’t know 

13. What would you or others label you as? (choose all that apply) Please select all that apply. 
[ ] Prep
 [ ] Goth 
[ ] Emo
 [ ] Punk
 [ ] Nerd
 [ ] Hipster 
[ ] Pothead
 [ ] Poser
 [ ] Skater
[ ] Druggie
 [ ] Normal 
[ 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) 
[ 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
 [ x] What happened for them to start cutting 
[ ] Fear 
[ x] Interest 
[ x] Sadness
 [ ] Happiness
 [ ] Don’t really care
 [ ] No reaction
 [ x ] Surprise
 [ ] Relief 
[ ] Jealousy
 [ ] Upset that nobody else cuts as bad as me
 [x ] Happy that nobody else cuts as bad as me