FACSAFoundation.org Shattering The Silence Tour Documentary Project February 2015 Volume 3 | Page 100
Circle all that apply.
Drug/Alcohol
Sexual
Depression Suicidal
Drama
Addiction
Addiction
Cutting
Addiction
PTSD
23) I have problems trusting others. Circle
One
Strongly
Agree
Disagree Strongly
Agree
Disagree
Doesn’t
Apply
24) My family and I have a close relationship. Circle One
Strongly
Agree
Disagree Strongly
Agree
Disagree
Doesn’t
Apply
25) I trust my partner. Circle One
Strongly
Agree
Disagree Strongly
Agree
Disagree
Doesn’t
Apply
26) I respect my partner. Circle One
Strongly
Agree
Agree
Disagree Strongly
Disagree
Doesn’t
Apply
Weight Issues
Cutting