[x] experienced sexual violation
[x] experienced verbal abuse
[] experienced physical abuse
[x] experienced sexual abuse
[x] been bullied
[x] self-hate
[x] self-harm: cutting
[x] self- Harm: burning
[x] self-Harm: hitting
[x] self-harm: other
[] Suicidal thoughts
[] Attempted suicide
[x] One biological parent was absent from the majority of your life
[] You lived in a split household
[x] You were adopted
[] You had a serious childhood illness
[] You have undergone mental trauma
[x] Your family fought
[ ] Your grew up in an impoverished area
[x] Your family was in poverty when you were a child
[x] You have/had an eating disorder or are recovering/recovered
[] You’ve looked at thinspo in order to motivate you to lose weight
[x] You’ve tried starving yourself
[] You are/were an alcoholic.
[ ] You have/had a sexual addiction.
[x] You have/had a self-harm addiction.
[] You have/had a different addiction.
[x] You have had no friends at one point in your life.
[x] You’ve been lonely.
[x] You feel alone in the world.
[] You have social anxiety.
[] You’ve experienced dissociation.
[] You have a diagnosed dissociative disorder.
[ ] You may have an undiagnosed dissociative disorder.
[] You’ve tried drugs.
[] You’ve never drank.
[] You’ll never drink.
[x] You drink occasionally.
[] You drink socially.
[] You drink seriously.
[x] You smoke.
[ ] You chew tobacco.
[x] You quit smoking tobacco.
[ ] You have a diagnosed personality disorder.
[ ] You may have an undiagnosed personality disorder.
[x] You have phobias.
[x] You may have undiagnosed phobias.
[x] You have/had depression.
[x ] You feel you have anger problems.
[x] You have seen a therapist/counselor.
[x] You have a hard time trusting others.
[x] You’ve been in a minor car accident.
[ ] You’ve been in a serious car accident.
[] You are Catholic.
[ ] You are Muslim.
[ ] You are Jewish.
[ ] You are Wiccan.
[ ] You are agnostic.
[] You are atheist
