Self-Image

* What gender are you?

Male

Female

* I have a ______ self-image.

Positive

Negative

* What factors do you believe have an effect on your personal self-image? (Select all that apply)?

* As you've got older, have you become more or less self-conscious about your body?

More

Less

About the same

* How often do you think a negative thought about your body? (For example, "I'm getting fat" or "My skin is a nightmare and everyone in the room is staring at my pores in disgust right now.")

Never or almost never

Once or twice a month

About once or twice a week

Once or twice a day

More than a few times a day

* Do you ever find yourself judging other people's bodies and appearances?

Always

Sometimes

Rarely or never

Depends

* Have you struggled with feeling insecure about your body?

Yes

No

* If yes, who/what made you feel that way? (Select all that apply)?

* Speaking in general, do you think girls today have…

Good body image. Most girls I know are confident.

Poor body image. Too many girls focus on how they look.

* Speaking in general, do you think guys today have...

Good body image. Most guys I know are confident.

Poor body image. Too many guys focus on how they look.