NIMH Trichotillomania Symptom Severity Scale

In the average day, for the past week, how much time did you spend pulling hairs?

Which hairs did you pull this week?

Scalp / head

Eyebrow

Eyelash

Arm / leg / body

Pubic

Other

If other, please explain:

How much time did you spend pulling hairs yesterday?

What were the thoughts or feelings preceding the pulling episode?

I felt anxious and this calmed me down.

I felt compelled to pull and reacted to that urge.

I had a troublesome thought and the ritual / habit or pulling made the thought "okay".

Other

If other, please explain:

Did you attempt to resist the urge to pull?

How much are you bothered by this compulsion / habit?

Not at all - 012345 - Very, very much

How much does hair pulling interfere with your daily life?

None - 012345 - A great deal

In what ways does hair pulling interfere with your daily life?

Resulting appearance is embarrassing or prohibits activities.

Interference because of time used pulling.

Other

If other, please explain:

Time is Up!

Get social with us