Asterix (truemaddeep411) wrote in escapexvelocity,
Asterix
truemaddeep411
escapexvelocity

Under the link is a survey I have made about SI in order for research purposes. Moderators, if this is unallowed, please feel free to delete this post. Surveyors, some topics in the survey may be triggering and uncomfortable, please read the disclaimer before you continue. Thank you for your time.

Disclaimer: this survey is on a strict volunteer basis where anonamosity is respected. There are topics in this survey that people may find triggering or uncomfortable, if you wish to continue this survey please feel free to skip any answers you do not wish to answer. Above all, I ask that you answer honestly in the hope that these results can help others. Those who fill out this survey are encouraged to elaborate on their answers to provide additional information.

Gender:
Male
Female
Transgendered
 
Sexual Orientation:
Heterosexual (opposite genders)
Homosexual (same genders)
Bisexual (both same and opposite genders)
Asexual (no sexual inclination)
Other (explanation)
 
Race:
 
Current Age:
 
Age when you first started to self injure:
 
Why did you start to self injure? What there a turning point in your life that drove you to self injury?
 
How do you self injure?
Cutting
Burning
Hitting yourself
Hitting objects
Skin picking
Scratching
Wound interference
Bone Breaking
Biting
Trichotillomania (hair pulling/plucking)
Carving
Branding
Incertion of objects into skin
Excessive drug use
Excessive alcohol use
Anorexia
Bulimia
EDNOS
Other (describe)
 
Where on your body do you self injury? (please be specific)
 
Do your parents/guardians know you self injure? If so, how did they find out? How did they react?
 
Does your significant other, past or present, know you self injure? If so, how did they find out? How did they react? (if single or n/a, indicate)
 
Have you ever seen a professional (therapist, psychiatrist, councilor, ect) about your self injury? If so, how did they react? Did they help? If not, why? Would you like to?
 
Have you ever received medical attention for a self inflicted wound? If so, what was their reaction?
 
Have you ever been diagnosed with a mental disorder? If yes, please indicate.
If yes, do you think it is a factor to your self injury?
If no, do you believe that you have an undiagnosed mental disorder? If yes, please indicate.
 
Have you been suicidal in the past?
Are you currently suicidal?
Have you ever tried to commit suicide?
 
Do you consider your self injury a secret? If so, to who?
 
Are you ashamed or embarrassed that you self injure?
 
Do you self injure to:
Punish yourself?
Feel ‘alive’?
Calm you down?
 
How do you feel before, during and after you self injure?
Before:
During:
After:
 
Do you hide your self inflicted wounds? How?
Do you hide your self injury tools/material? How
 
Do you suffer from:
Low self-esteem
Self-hatred
Bullying
Perfectionism
Unsociable behaviors
Severe mood swings
 
Have you ever been verbally abused?
Have you ever been physically abused?
Have you ever been sexually abused/molested/raped?
 
What is the longest you have gone without self injuring? (in months and weeks, please)
 
Do you want to stop self injuring?
Have you tried to stop self injuring?
Are you currently trying to stop self injuring?


Please email all completed surveys to dancinginthedarkness@hotmail.com
Feel free to email questions, comments and complaints
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