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NIMH Trichotillomania Symptom Severity Scale

If you would like a copy of your answers and results emailed to you, please provide your email address here:

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

Where on your body did you pull/pick this week?

Scalp / head

Eyebrow

Eyelash

Arm / leg / body

Pubic

Other

If other, please explain:

How much time did you spend pulling hairs/picking skin yesterday?

What were the thoughts or feelings preceding the pulling/picking 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/pick?

How much are you bothered by this compulsion / habit?

Not at all - 012345 - Very, very much

How much does hair pulling/skin picking interfere with your daily life?

None - 012345 - A great deal

In what ways does hair pulling/skin picking 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!

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