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Self-Harm Inventory

A common symptom of betrayal trauma is self-harm. Betrayal trauma is likely to cause one to start or exacerbate self-harming activities such as cutting, problematic eating, or substance abuse. This assessment provides valuable information in the assessment phase of the therapeutic relationship, but if this is triggering or feels too intrusive, please don’t feel obligated to continue. Please be gentle with yourself and take care of yourself if you find yourself triggered.

Self-Harm Inventory

Name

Have you ever intentionally, or on purpose, done any of the following:

Overdosed?(Required)
Cut yourself on purpose?(Required)
Burned yourself, scratched yourself, hit yourself, or banged your head on purpose?(Required)
Been promiscuous?(Required)
Distanced yourself from God as punishment?(Required)
Abused alcohol, drugs, or prescription medication?(Required)
Lost a job or caused yourself financial consequences on purpose?(Required)
Attempted suicide?(Required)
Tortured yourself with self-defeating thoughts?(Required)
Starved yourself or abused laxatives to hurt yourself?(Required)

Relationship to food

Do you make yourself sick because you feel uncomfortably full?(Required)
Do you worry you have lost control over how much you eat?(Required)
Have you recently lost more than 15 lbs in a three-month period?(Required)
Do you believe yourself to be fat when others say you are too thin?(Required)
Would you say food dominates your life?(Required)
Review and uncheck if not applicable

 

Also Read:
Online Group for Sex Addiction Recovery
Sex Addiction Recovery