standard intake questionnaire

Posting this for the honesty & general relevance as to background/ current context information.


What brings you to counseling at this time? Is there something specific, such as a particular event? Be as detailed as you can.
I just spent 8 weeks in an inpatient facility for anorexia-bulimia. This eating disorder, however, was born as a coping mechanism for recurring trauma in the past. Now that I have regained weight and brain/body function, the flashbacks & nightmares have returned full force and I cannot-- and will not-- turn to disordered behavior to "smother" or "bury" those trauma symptoms. I have never discussed them in therapy before, but if I want to prevent relapse or another abusive addiction development, I need to bravely do so now.

What are your goals for counseling?
Mainly: to admit & process & manage feelings of guilt, rage, shame, self-hatred, fear, etc. related to past traumas; also to cope with nightmares, flashbacks, body sensations, etc. that constantly "re-open the wound" as it were. My symptoms are making daily life extremely difficult and this will only worsen if not dealt with.

Have you seen a mental health professional before?
Yes; I have probably seen over 20 different mental health professionals since childhood, for various reasons. In adulthood, I did specifically seek treatment for trauma (esp. abusive) but "co-morbid" symptoms regularly forced me to switch providers after a few months, and I never made real progress; I would have to stop before getting the guts to actually discuss-- or even admit-- the roots of my symptoms.

Have you ever attempted suicide?
Yes; In the past, I would constantly "flirt with death" and "experiment" with potential suicide methods: cutting wrists or throat, overdosing, jumping, poisoning, hanging, suffocation, etc. I would regularly-- almost mechanically-- check my environment for "possible options" and then "practice" for the ultimate event. I made a solid attempt at least three times that I readily remember? Once by blood, once by meds, once by poison. All happened during traumatic life situations and were "my exit door" from what felt fatal regardless.

Do you have thoughts or urges to harm others?
...Yes. Those are rare, and never premeditated, but are violent enough to merit acknowledgement. Such urges only occur when I am in (perceived) danger, especially when trauma is triggered, or when overwhelmed by rage and/or hyperstimulated. The "harm" is only ever meant to "stop what is hurting ME," never as a personal attack, and it occurs almost without conscious awareness. Typically afterwards, when I realize and/or am TOLD what I did, I am horrified and remorseful. Still, I cannot think of what else COULD have been done at the time; I had most likely been cornered & just lashed out like a rabid animal.

Have you ever been hospitalized for a psychiatric issue?
Yes-- once for self-abuse in 2012, twice for anorexia/bulimia in 2017 & 2022, once for an unexplained 302 call in 2018. The ED stays were approx. 8-9 weeks each; the psych stays were 5-7 days.

Is there a history of mental illness in your family?
Yes-- two sisters (transgender) have major anxiety/depression; one has paranoid schizophrenia & the other is agoraphobic with severe panic attacks. Mother has ADHD and possibly a mood disorder. Grandmother had OCD. Great Aunt had severe psychosis. Grandfather had extreme anger issues & hoarding tendencies. Father has a history of panic attacks. In general mental illness in our family is shockingly apparent but never discussed or admitted unless it becomes intolerable and/or dangerous.

If you are in a relationship, please describe the nature of the relationship and months or years together.
Too complicated to summarize.

Please check any of the following you have experienced in the past six months:
Increased appetite /  Decreased appetite /  Trouble concentrating / Difficulty sleeping / Excessive sleep / Low motivation / Isolation from others / Fatigue / Low energy /  Low self-esteem / Depressed mood / Anxiety / Fear / Hopelessness / Panic
Other: Dissociation, flashbacks, nightmares, body & gender dysphoria, disturbing intrusive thoughts, "hearing voices," magical thinking, etc.

What else would you like me to know?
I have a previous "tentative diagnosis" of D.I.D. and although it went into forced remission after our last abusive friendship, trauma & emotional distress invariably triggers symptoms full-force. Most of our trauma memories are "locked" in specific individuals that we cannot readily find or communicate with as of now, so memory gaps are frequent and large. We are hoping to become able to face those memories in therapy.