Track Your Hair Pulling Symptoms
Choose a time where you're noticing yourself pull or feel the URGE to pull. Try to do this a few times a week so we can find some common patterns.
Email *
What time is it? *
Time
:
How much time did I spend pulling? *
Where am I currently? (room, kitchen, school, work, etc) *
How aware am I that I am/was pulling? *
What am I doing right now? Reading, TV, games, etc *
EMOTIONS
What is my urge to pull? *
Low Urge
High Urge
What am I feeling right now? *
Required
THOUGHTS
What thoughts am I having right now? *
SENSATIONS
Do I feel anything in my body that signals me to pull? (Itch, heartbeat, tingling, etc) *
Think back: How did my hand get to the pulling site? Any detail possible.
A copy of your responses will be emailed to the address you provided.
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