Self harm

How old are you ?

• - 11 years old.
• 12 - 13 years old.
• 14 - 15 years old .
• 16 - 17 years old.
• 18 - 19 years old.
• 20 + years old.

Have you ever self harm ?

• Yes, I'm still do it.
• Yes, but I stopped it.
• Yes, but I try to stop it.
• No, but I want to try it.
• No, ever.

How do you self injury?

Please select all that apply.

• I cut myself.
• I burn myself.
• I scratch myself.
• Other.
• I don't cut.

With what do you self harm ?

Please select all that apply.

• With scissors.
• With knifes.
• With razor blades.
• With needles.
• Other.
• I don't cut.

Since when do you self harm ?

• Since 6 months or less.
• Since 7 months - 1 year.
• Since 1 - 2 years.
• Since 3 - 4 years.
• Since 5 - 6 years.
• Since 7 - 8 years.
• Since 9 - 10 years.
• Since more than 10 years.
• I've stopped cutting.
• I have never cut.

Do you have any other psychological issue(s) ?

Please select all that apply.

• Eating Disorders.
• Depression.
• Bordeline.
• Bipolar.
• Anxiety.
• Obsessive Compulsive Disorder.
• Paranoia.
• Other.
• None.

Do you tell that your problem(s) to someone ?

Please select all that apply.

• Yes, to my best friend(s).
• Yes, to close friend(s).
• Yes, to some friend(s).
• Yes, to my parents.
• Yes, to my doctor.
• No, but I want to.
• No, and I never want to.
• I don't cut.

Do you want to stop cutting ?

• Yes, I really want to.
• Yes, I have already stopped.
• Yes, I've already tried but I failed.
• Maybe, one day.
• Maybe, but I'd need help from someone.
• No, but I have tried to stop.
• Not now.
• I have never cut.

Do you take care of your wounds ?

• Yes, a lot (I disinfect them, I put bandages on them ...).
• Yes, a bit.
• Yes, sometimes.
• No, but I've done it.
• No, never.
• I don't cut.

How often do you self harm ? (Average)

• Several times a day.
• One time per day.
• Several times a week.
• One or two times a week.
• One or two times a month.
• I don't cut.

Have you ever had suicidal thoughts ?

• Yes, I have already tried to kill myself.
• Yes, I really want to die.
• Yes, but I don't want to die yet.
• Yes, sometimes.
• Yes, I've tried to commit suicide but I've stopped to have suicidal thoughts.
• No, I'm really scared of dying.
• No, never.

After what do you cut ?

Please select all that apply.

• When I failed at something.
• When someone hurted me.
• When I feel alone.
• When I'm sure that I'll failed at anything/something.
• When I want it, without any reason.
• Other.
• I don't cut.