Exit this survey Shame and Secrets Survey 1. 50% of survey complete. Question Title * 1. Because this survey is about our deepest darkest shame and secrets, it is completely anonymous. Absolutely no personal information is being gathered about you - only your responses to these questions - not even the I.P. address of your computer. My hope is this freedom will enable you to unload your shame and allow others to see they are not alone. Please come up with a nickname to hide your identity in the event I read your responses on the show. If you are feeling suicidal PLEASE call the Suicide Prevention Hotline 800-273-8255. Question Title * 2. What gender are you? Man Woman Gender fluid Trans Man Trans Woman Agender Other (specify in text box below) Other (please specify) Question Title * 3. Have you ever been the victim of sexual abuse? Yes and I reported it Yes and I never reported it Some stuff happened but I don't know if it counts as sexual abuse No I have never been sexually abused If you're comfortable sharing it, what happened and how do you feel about it? Question Title * 4. Have you ever been physically or emotionally abused? If you're comfortable sharing, what happened? Never been physically abused Never been emotionally abused Been physically abused Been emotionally abused Not sure If you're comfortable sharing it, what happened and how do you feel about it? Question Title * 5. If you have been abused are there positive experiences with the abuser(s) and does that complicate your feelings about them or what happened? Question Title * 6. What are your deepest darkest thoughts? Not things you would act on, but things you are ashamed to admit you think about. Question Title * 7. What are your deepest darkest secrets (things you have done or things that have happened to you)? Question Title * 8. Are you gay, straight, bisexual or asexual (not interested in either sex)? Gay Straight Bisexual Pansexual Asexual Other (specify in text box below) Other (please specify) Question Title * 9. How old are you? 21-30 31-40 41-50 51-60 61-70 Other (please specify) Question Title * 10. What best describes the environment you were raised in? Stable & Safe A Little Dysfunctional Pretty Dysfunctional Totally Chaotic Other (please specify) Next