E-mail address
Are you completing this on behalf of a child
Sex What age did you start pulling?

What usually triggers a pulling spree for you? What usually helps you to stop pulling?

Have you ever been pull free for any period of time? If so, how did you achieve this status and how long for? Please tick where you pull from. Select as many options as apply to you.

Eyebrows Lashes Legs Beard
Scalp Chest Pubic region Hands and/or feet
Underarms Dog/s Cat/s Other pets
  Nose and ear hair Other people  

Was your father present when you were growing up?

Did the start of your pulling coincide with your parents’ divorce or separation?

Do you have a difficult relationship with your parent(s)

Were you :

Emotionally abused as a child physically abused as a child Sexually abused as a child

What memorable events occurred in your life the year you started pulling?


Would you say your trich was at its worst during winter months?

Have you ever been prescribed medication for trich? If so, please name the brand and state whether you found it successful. This data will be analysed and used to help others decide whether or not to take such medication.

Doctor’s approach to trich?

Were you hyperactive as a child

Do you have ADD (Attention Defecit Disorder)

Have you ever been diagnosed as having any other disorder or condition? If so, which?

Do you have a partner/spouse

Are you gay?

How have previous partners responded to your trichotillomania, if you have told them.

Did/does trichotillomania affect your ability to interact and to find a partner?

Do you wear a wig? If so, do you wear synthetic or real hair?

Approximately how much money per month do you spend on trich related purchases, such as wigs, bandanas, scarves, hats, eyeliner, false lashes etc?

If you found this site through a search engine, which search engine did you use and what did you type as your search criteria?

Are you a shy person?

Who do you pull in front of? (If everyone, just tick anyone, not all boxes!)

Parents Close family Friends
Anyone as I can’t control it. Nobody sees me pull. Other

Do you :

Munch the white hair follicle. Eat the whole hair  
Discard the hair (only select this option if none of the others apply) Rub hairs on your face/stomach/lips  
Look at the white hair follicle Collect certain types of hairs together  
Store hairs in a specific place, such as under the bed.(please explain below) Other (please explain)  
Convince yourself you will stop when you find the “right” hair.  

When did you first look at trich related sites on the Internet?

How did you feel when you first noticed other trichsters were out there?

Which sites do you find most helpful? Please list one url per line.

What do you think of this website?

Have you found friends with trich on the Internet?

Would you like a trich buddy? By ticking this box you agree to your email address being passed to a potential buddy. We will not release it to anyone else.

Buddy Statement (state why you would be a good buddy & what type of person you would like as your buddy. (Ignore if you have not applied for a buddy)

Do you attend any trichotillomania related clinics or events?

Would you be interested in attending events etc.

Do many of your friends know you have trich?

What is your astrological star sign?

What is your date of birth?

Career (if any)

Do you feel that your trich has held you back with regard to your career?

Do you find it easy to express anger?

Do you find it easy to get close to people?

May we contact you (this is likely to be very infrequent and we will not pass your data to anyone else) to advise of updates and events in the trich world? If so, should we use this e-mail address? Telephone number or address may be supplied if you prefer.


Are there any questions which you feel we have missed out and would like to see added to this questionnaire?

Please tick this box if you do not wish to receive an occasional (possibly bi-monthly) email with updates on trich treatments or if your email is not private and you don’t want us to contact you. We do not spam and we won’t pass your email address to anyone else.

NOTE … IF YOU TICKED THE BOX ABOVE, YOU WON’T RECEIVE A BUDDY BECAUSE WE WON’T BE ABLE TO CONTACT YOU TO TELL YOU ABOUT IT. We also need your date (including year) of birth if you want a buddy, so we can match your ages).

Thank you so much for your time! Welcome to the Site.

Press submit and wait. Please don’t submit your questionnaire more than once. Thank you.

Updated 17 July 2022 review 18 July 2023