Experiences with bullying

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1. How old are you?

10 - 19 years
20 - 29 years
30 - 39 years
40 - 49 years
50 - 59 years
More than 60 years

2. Where have you born?

United Kingdom
United States
Other (please specify):

3. Do you prefer others before yourself?

Yes
No
Maybe

4. Do you have in your family one of the following illnesses?

Cancer
Mental disorder
Attention deficit disorder ADD
Alzheimer
Multiple sclerosis
Hyperactivity
No, I don't have one of those

5. How often are you ill?

Very often
Not too often

6. Do you consider yourself as a sensitive personality?

Yes
No
Maybe

7. Once something uncomfortable happens and you don't know how to handle it, do you react by changing of your attention?

Yes
No
Maybe

8. Do you wish acceptance from others?

Yes
No
Maybe

9. Do you fear of rejection?

Yes
No

10. Do you have sudden strong feelings?

Yes
No
Perhaps yes

11. Would you like to share anonymously your experience with bullying?

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