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This is a survey that is completely anonymous, you do not have to reveal your name or e-mail address unless you choose to do so in the “Comments” area of the survey. You don’t have to answer any question that makes you uncomfortable or that you just don’t know. Thank you everyone who chooses to share their story for their courage; and be proud of yourself!

General Questions
What is your gender?
What is your sexual orientation?
What is your job? Are you a student? (e.g. high school student, doctor, etc.)
What is your current age?
At what age did you begin self-injuring?
Self-Injury Questions
What is your main method of self-injury (e.g. cutting, burning, hitting, etc.)? Do you have any others?
Do you feel pain when you self-injure? Or have you dissociated?
Do you have any rituals related to an act of self-injury?
Do you know any other self-injurers (e.g. a friend, classmate, family member, etc.)? Have they had any influence on your own self-injury?
Have you every told anybody you self-injure? If yes, then who?
Since you've told has living with your self-injury been easier or more difficult? If you haven't told how do think things would change if you did?
Do you have any coping skills (methods) that help stop you from self-injuring? If so, what are they?
Have you ever had to seek medical attention for your injuries? What were the attitudes you encountered from medical professionals?
Have you ever gone into therapy to treat your self-injurious behavior? Have you ever gone in-patient at a psychiatric hospital because of your self-injury or for any mental illnesses that cause you to self-injure?
Do you take any medication for your self-injury or for any mental illness that causes you to self-injure? If yes, which medication?
Other Issues
Do you have any other mental illnesses, personality disorders, or addictions?
Have you ever suffered any abuse (emotional, physical, sexual)? (Note: If you don't feel comfortable you have the choice not to answer the question)
Comments? Would you like to describe any other aspect of self-injury? Feel free to put whatever you think or feel, etc. down.
If you answered anything but 'No' to the previous question do you want anything to be absolutely not put on the site or anything connected with the site?
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