Skin-Picking Research Questionnaire - Trichotillomania Support

This questionnaire relates to skin picking. Here is our hair pulling questionnaire. If you have another BFRB, please contact us. Please take your time with the questionnaire and possibly have a break midway – talking about your compulsive behaviour can be an emotional experience. We know it is a long one but it does help so much. We will never pass your details on to anyone else.

Name

May we contact you? If you click no, then of course we can't give you a buddy.

How did you find the form?

Gender

Preferred pronouns

Did the start of your picking coincide with your parents' divorce or separation, or moving house or school?

Age when skin picking started

Country

District

Triggers - please list what triggers your skin picking

Have you ever been pick free? If so, how did you achieve this status and for how long?

Times when you do not pick - what usually helps?

Ritual: do you examine, play with, taste or eat the skin

Date of birth

Were both parents present when you were growing up?

Do you have a difficult relationship with a parent or step-parent?

Abuse as a child

Abuse related information - what should we know?

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

Have you ever been prescribed medication for anxiety or skin picking? 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.

Have you ever been diagnosed with any other condition or disorder, please list, thank you.

Doctor's approach to skin picking?

Hyperactive as a child

Are you a shy person?

Do you easily express anger?

Is it easy for you to get close to people?

Would you like a buddy?

What would you like to say about yourself, to your buddy (if you asked for one)

Who do you pick in front of?