Screening for Mental Health, Inc.
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This survey is designed for people who have hurt themselves on purpose without wanting to die. Self-injury (also called self-harm or non-suicidal self-injury) is when someone intentionally hurts their body as a way of coping with difficult emotions or situations. Common forms include cutting, burning, scratching, hitting, or other methods of intentionally causing physical harm. This survey takes 5-10 minutes to complete and helps you and healthcare professionals understand patterns and reasons for self-injury so you can get the most effective support. Your responses are completely anonymous and confidential. Important note: If you’re thinking about suicide or have thoughts of ending your life, this is not the right survey for you. Please seek immediate help by calling or texting 988 (Suicide & Crisis Lifeline), texting HELLO to 741741 (Crisis Text Line), or calling 911.
Important Disclaimer:
This is an assessment tool only, not a diagnosis. Self-injury can be treated and recovery is possible many people stop self-harming with proper support and healthier coping strategies. Please discuss your results with a healthcare provider, therapist, school counselor, or trusted adult. If you’re in crisis or having thoughts of suicide, seek immediate help by calling 988 or 911. All responses are anonymous and confidential.
Self-injury means deliberately hurting yourself without wanting to die. It’s a coping mechanism, though an unhealthy one, that people use when they’re overwhelmed. Common methods include: cutting skin with sharp objects like razors, knives, or broken glass; burning skin with cigarettes, matches, or other hot objects; scratching or picking skin severely until it bleeds or scars; hitting or punching yourself, walls, or other objects; preventing wounds from healing by picking at scabs; carving words or symbols into skin; pulling hair out (trichotillomania); and biting yourself hard enough to leave marks or break skin.
People hurt themselves for various complex reasons, often to cope with overwhelming emotions they don’t know how to handle. Common reasons include: to cope with overwhelming feelings like sadness, anger, or anxiety; to feel something physical when feeling emotionally numb or disconnected; to punish themselves when feeling guilty or self-hatred; to express emotional pain they can’t put into words; to regain a sense of control when life feels chaotic or out of control; and to distract from emotional pain by creating physical pain. Self-injury is not attention-seeking. It’s a sign that someone is struggling deeply and needs compassionate support and healthier coping strategies.
To get the most from this assessment, answer honestly about your experiences with self-injury. Think about your behavior over the past year, including recent patterns and changes. There are no right or wrong answers. This is about understanding your experience. You can stop at any time if you feel uncomfortable or overwhelmed. Some questions may be difficult or triggering, so take breaks if needed. Take your time and answer as accurately as possible to help identify the support you need.
If this survey becomes triggering:
6. When you hurt yourself, how often is it for each of these reasons? (Rate each: Never / Sometimes / Often / Always)
To cope with feelings:
Communication and control:
Physical and mental states:
13. Has self-injury affected your: (Rate each: Not at all / A little / Quite a bit / Very much)
This survey helps identify patterns in self-injury behavior and the functions it serves. There’s no “score” that determines severity, but your answers can help you and a mental health professional understand several important aspects of your experience.
Frequency and recency: Recent and frequent self-injury suggest you need professional support soon to develop healthier coping mechanisms. Past self-injury that has stopped may still benefit from understanding triggers and preventing relapse.
Functions and reasons: Understanding why you self-injure is absolutely key to finding healthier alternatives that serve the same purpose. Most people self-injure to regulate overwhelming emotions or cope with psychological distress. Different reasons require different treatment approaches what works for emotional regulation may differ from what helps with numbness.
Impact on life: Consider how much self-injury affects your relationships with family and friends, your physical health and scarring, and your daily functioning at school or work. Think about whether you’re hiding the behavior or have support, and what medical risks you may be facing from your methods.
Readiness for change: Your answers reveal where you are in thinking about stopping, what barriers exist to change, and what support you might need to succeed in recovery.
What to do with this information: Share your responses with a therapist, counselor, primary care doctor, psychiatrist, or other mental health professional. They can help you understand your behavior patterns and develop healthier, more effective coping strategies.
Self-injury can be overcome with the right support and treatment. Many people successfully stop self-harming and develop healthier ways of coping. Effective treatments include:
Therapy:
Support approaches:
When you have the urge to self-injure, try these alternatives that provide similar relief without causing harm:
Your primary care doctor or pediatrician: The first step for mental health referrals and connecting with specialized care.
Mental health specialists: Psychologists, therapists, and psychiatrists who specialize in self-injury, DBT, or trauma. Find providers through your insurance network or Psychology Today’s therapist directory.
Crisis and specialized services:
Self-harm support organizations:
Insurance coverage: Most health insurance plans cover mental health treatment under the Mental Health Parity Act. Medicaid also covers mental health services in all states. Contact your insurance provider to understand your benefits and find in-network therapists.
Emergency services: Call 911 or go to your nearest emergency room
Crisis helplines (available 24/7):
Suicide prevention: If you’re thinking about suicide rather than self-injury, call the helplines above immediately, call 911, or go to the nearest emergency room. You deserve help and support.
For a friend worried about someone: Encourage them to seek professional help, tell a trusted adult like a parent, teacher, or school counselor, or call a helpline for advice on how to support them. Don’t promise to keep serious self-injury or suicidal thoughts secret.
How to respond:
What not to say:
Supporting recovery:
About Self-Injury: Self-injury affects approximately 1 in 5 people at some point in their lives, with the highest rates occurring during adolescence and young adulthood. Research shows it’s often associated with difficulties regulating emotions and frequently occurs alongside depression, anxiety, PTSD, eating disorders, or borderline personality disorder. With proper treatment, most people can stop self-injuring and develop healthier coping mechanisms.
Important disclaimer: This survey is an assessment tool, not a diagnostic instrument. It cannot replace professional evaluation by a qualified mental health provider such as a psychologist, psychiatrist, or licensed therapist. If you’re experiencing thoughts of suicide or are in immediate danger of harming yourself seriously, seek emergency help by calling 988, texting HELLO to 741741, calling 911, or going to your nearest emergency room. Self-injury is treatable and recovery is possible with proper support and evidence-based treatment. This tool is for informational and educational purposes only. We do not store or collect personal health information, ensuring your privacy is protected in accordance with HIPAA regulations and applicable privacy laws.