Coping Methods Inventory
Please identify methods of coping that you have used in the last 30 days to change your mood, relieve stress or prove value. This form is encrypted, only input data is kept for research purposes. There are no methods or purposes in place for tracking source data.
Exceptions to Confidentiality
The Federal government and virtually all states require anyone who has knowledge of - or in some states has reason to suspect - abuse of a minor, including sexual abuse, to report such information whether or not the minor received any injury. FMM will comply with these laws and make such a report if it comes to knowledge of or suspects any such abuse.
Gender
*
Please Select
Male
Female
Age
*
Under 20
21 - 30
31 - 40
41 - 50
51 - 60
61 - 70
71 +
Relationship Status
*
Single
Married
Divorced
Widow
BODY IMAGE
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Self-Harm
Sports
Fitness
Cosmetic Procedures
Plastic Surgery
POSSESSIONS
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Spending
Hoarding
Stealing
PERFORMANCE
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Workaholism
Career
Talent
Ministry/Acts of Service
Procrastination
ENTERTAINMENT
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Gaming
Gambling
Movies
Soap Operas
TV
Internet
Social Websites
Novels
DRUGS (Over The Counter, Legal or Illegal)
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
OTC
Abused Rx
Not My Rx
Illegal
ALCOHOL
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Alcohol
SEXUAL BEHAVIORS
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Fantasy
Romance Obsession (Emotional Affairs, Online Stalking)
Dating Apps
Masturbation
Affairs, Prostitution, Strip Clubs
Pornography
Gaming w/Sexual or Violent Stimuli
Anime
Furry Persona w/Sexual Deviance
Anonymous Sex
Same Sex Attraction
Exhibitionism /Voyeurism / Frotteurism (non-consensual rubbing)
Cyber Sex (Phone, Sexting, Digital/Virtual)
BDSM (Pain Exchange: Bondage, Discipline, Sadism & Masochism)
Bestiality
Offending (Rape, Incest, Child Molestation, Authority Rape)
Child or Minor Pornography
Attraction to Minors
Sexual Anorexia
Erotic Movies, Novels or Audio
Romantic Movies or Novels
FOOD
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Bulimia
Anorexia
Bingeing
Night Eating
RELATIONSHIPS
Rows
Not Appealing
Past Use Not Currently Active
Intrigued
Active Once a Month
Active 2-3 x Month
Active Weekly
Active 2-5 x a Week
Active Daily
Active Multiple x Daily
Dating
Marriage
Children
Family
Friends
Email
example@example.com
I would like a follow-up regarding recovery help.
Yes
Submit
Should be Empty: