Part Four

This section is for the people who already identifies himself or herself as a self-injurer.

54. I often obsess about self-injury.
True____ False____

55. I sometimes can't explain where my injuries come from.
True____ False____

56. I get anxious when my wounds start to heal.
True____ False____

57. I often believe that if i don't self-injure, i'll go "crazy".
True____ False____

58. No one can hurt me more than i can hurt myself.
True____ False____

59. I can't imagine life wthout self-injury.
True____ False____

60. If i stop self-injuring, my parents win.
True____ False____

61. I often believe that if i don't self-injure, i'll explode.
True____ False____

62. I almost always carry something with me that i can use to self-harm.
True____ False____

63. I often self-injure as a way to punish myself.
True____ False____

64. I often self-injure to show others how bad i feel.
True____ False____

65. Self-injury helps me to feel in control.
True____ False____

66. I have carved words or symbols into my flesh.
True____ False____

67. I have used self-injury to control others.
True____ False____

68. The sight of my blood comforts me.
True____ False____

69. Self-injury helps me feel "real" again.
True____ False____

70. Self-injury helps me control my mind when it is racing.
True____ False____

71. Self-injury helps me feel relaxed.
True____ False____

72. Self-injury helps me feel less lonely.
True____ False____

73. Self-injury helps me feel less depressed.
True____ False____

74. Self-injury is my best friend.
True____ False____

75. The first time i self-injured, i didn't let anyone know.
True____ False____

76. I have self-injured:
Only once____ 2-5 times____ 6-10 times____ 11-20 times_____ 21-50 times____ More than 50 times____

77. My decision to self-injure is usually made (check all that apply):
On the spur of the moment____ An hour before____ Several hours before____ A day before____ A week before____ More than a week before____

78. I often have a regular routine i follow when i self-injure.
True____ False____

79. Immediately after i self-injure, I usually feel:
Better____ N change____ Worse____

80. The amount of pain i feel when i self-injure is usually:
None____ A little____ A moderate amount____ A great deal____

81. I have lost friendships because of my self-injury.
True____ False____

82. I am unable to hold down a job because of my self-injury.
True____ False____

83. I have at time missed school because of my self-injury.
True____ False____

84. I like the attention i get from people when they find out that i have physically harmed myself.
True____ False____

85. List the ways in which you have harmed yourself. List them in the order in which you most often harmed yourself, e.g., 1, Cutting, 2. Burning, ect.
1.____ 2.____ 3.____ 4.____ 5.____

86. When did you last harm yourself?
Within the past week ____ Past month____ Past year____ More than a year ago____

87. My self-harm helps me atone for my sins.
True____ False____

88. Sometimes my self-harm puts me in a closer contact with God.
True____ False____

89. I consider my tendency to self-harm as an addiction.
True____ False____

90. Many times i harm myself more out of habit than for any specific reason.
True____ False____

Part Four B

Questionnaire Index

Home