Cutting & Self-Abuse  
 
Read more about Cutting & Self-Abuse
Please provide us with your child's gender
Gender : Male Female  
 
1. Does your mind race with horrible thoughts and feelings which you want to stop, but can't?
 
Constantly
Often
Sometimes
Rarely
Never
   
2. Do you have urges to cut your skin with a sharp object?
 
Constantly
Often
Sometimes
Rarely
Never
   
3. Is your mind so full of numbing tension that you want to stop, but cannot?
 
Constantly
Often
Sometimes
Rarely
Never
   
4. Do you have urges to burn yourself?
 
Constantly
Often
Sometimes
Rarely
Never
   
5. Have you or do you have urges to drink or snort a toxic substance such as hairspray or paint?
 
Constantly
Often
Sometimes
Rarely
Never
   
6. Have you or do you have urges to punch yourself or bang your head against the wall?
 
Constantly
Often
Sometimes
Rarely
Never
   
7. How often do you cut, burn, punch, or otherwise hurt yourself?
 
Constantly
Often
Sometimes
Rarely
Never
   
8. Do you feel pain when hurting yourself?
 
Constantly
Often
Sometimes
Rarely
Never
   
9. Does your family and friends try to get you to stop hurting yourself?
 
Constantly
Often
Sometimes
Rarely
Never
   
10. Do your family or friends try to get you to stop hurting yourself?
 
Constantly
Often
Sometimes
Rarely
Never
   
11. Do you use the threat of hurting yourself as a coping skill to get others to respond to you the way that you want?
 
Constantly
Often
Sometimes
Rarely
Never
   
 
   
 
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