Personal TTM Questionnaire
Please do not send answers!!
You can send comments to John Kender, but don't answer the survey and send it to him!! If you do, he can get into trouble at his university.
This is a draft of a survey regarding trichotillomania, created by
members of the ttm mailing list. It is under development, and comments should be sent to
kender@cs.columbia.edu, who maintains it. At present, its only purpose is to compile the
concerns of people with the disorder, and to indicate those
aspects of other behavior which some of the list members feel may be related. Because of
several medical and legal reasons, it does not appear to be advisable for people to
respond to it in this form. However, list members are encouraged to use it for discussion
on the list, or with medical professionals
who may eventually be pursuaded to pursue these issues. This survey may be freely
distributed.
PLEASE DO NOT SEND ANSWERS!
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THE GRASS-ROOTS TTM SURVEY (aka THE HALLOPOLL)
PART 1: PULLING BEHAVIORS
Subpart 1A: Pre-Pulling Behaviors
This subpart asks you about your experiences *prior* to actually pulling
your hair. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1A01 Anxiety, agitation, or increasing tension
1A02 Aggravation, irritation, or anger
1A03 Increase in non-TTM obsessive-compulsive behaviors
1A04 Boredom, mental idling, or mental preoccupation
1A05 Localized itch or "hair feeling out of place"
1A06 Touching, massaging, or scratching of skin nearby
1A07 Stroking, tugging, or twisting of hairs
1A08 Deliberate "hunting" for "certain" hairs
1A09 Exploration with tools: tweezers, etc.
1AT1 (Text) Describe the "certain" hairs that are hunted for
1AT2 (Text) Other comments on pre-pulling behaviors
Subpart 1B: Areas Pulled
This subpart asks you to measure the extent of your pulling on various
parts of your (or someone else's) body. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
In general, these questions ask about the *frequency* of a behavior.
1B01 Crown or top of head
1B02 Sides of head
1B03 Back of Head
1B04 Eyebrows
1B05 Eyelashes
1B06 Nasal hairs
1B07 Chin, neck, or beard
1B08 Arms or hands
1B09 Armpits
1B10 Chest, breasts, or nipples
1B11 Pubic areas
1B12 Anal areas
1B13 Legs or feet
1B14 Other areas of your body
1B15 Areas of another person's body
1B16 Areas of a pet's body
1BT1 (Text) Describe these other areas of your body
1BT2 (Text) Describe the areas of some other's body
1BT3 (Text) Other comments on areas pulled
Subpart 1C: Pulling Behaviors Themselves
This subpart asks you about your experiences *during* the actual pulling
of your hair. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
In general, these questions ask about the *frequency* of a behavior.
[But note that some ask for other numbers.]
1C01 Is rewarding
1C02 Is soothing, peaceful
1C03 First is soothing, but then becomes an irritating hot spot
1C04 Causes physical pain
1C05 Is during a sedentary activity (driving, reading, watching TV, talking
on phone, etc.)
1C06 Is during a stress situation (angry, depressed, feeling fat, on
deadline, worry, etc.)
1C07 Is in public
1C08 Is solitary
1C09 Is in front of a mirror
1C10 Done with tools (tweezers, etc.)
1C11 Done on individual hairs
1C12 Done in clumps
1C13 Amount of affected area pulled
1C14 Average time spent pulling [give hours per day]
1C15 Hand used to pull with [1=left, 2=right, 3=both]
1CT1 (Text) Describe any other feelings during pulling
1CT2 (Text) Describe usual pulling place (bed, bath, car, etc.)
1CT3 (Text) Other comments on pulling behaviors themselves
Subpart 1D: Post-Pulling Behaviors
This subpart asks you about your experiences *after* an *individual*
pull of a hair; a few then ask about a session. Use the following
scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1D01 Feeling is gratification, release, or relief
1D02 Feeling is gratification, release, or relief, particularly if the root
pulled out is fat
1D03 Feeling is frustration
1D04 Feeling is compulsion for more
1D05 Feeling is compulsion for more, particularly if the hair breaks or there
is no root
1D06 How likely is hair played with the fingers (curled, twirled, etc.)
1D07 How likely is hair smelled
1D08 How likely is hair touched to lip or face
1D09 How likely is hair pulled through teeth
1D10 How likely is root pulled off
1D11 How likely is root eaten
1D12 How likely is root used as a tiny paintbrush
1D13 How likely is entire hair eaten
1D14 How likely is hair dismembered
1D15 During a pulling session, how likely are pulled hairs "organized" (lined
up, counted, stuck to things)
1D16 During a pulling session, how likely do feelings become negative (shame,
anger, frustration) but pulling goes on
1D17 After a pulling session is over, how likely do feelings become or stay
negative (shame, anger, frustration)
1DT1 (Text) Describe what usually terminates an individual pull (what makes a
hair be "used up")
1DT2 (Text) Describe what usually terminates a pulling session
1DT3 (Text) Describe any other pulling-related rituals
1DT4 (Text) Other comments on post-pulling behaviors
Subpart 1E: Temporal and Environmental Effects
This subpart asks you to measure the extent that your TTM varies under
various circumstances. It is likely that for some of these questions
you will not have noticed any relationship at all; in that case, leave
the question blank. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1E01 Worse when sad or depressed
1E02 Better when happy
1E03 Worse during an illness
1E04 Worse after an illness
1E05 Worse after an infection
1E06 Worse after taking antibiotics
1E07 Worse when feeling chilled
1E08 Worse in the evening
1E09 Worse after lack of sleep
1E10 Worse in hot humid weather
1E11 Better in hot humid weather
1E12 Worse in cold dry weather
1E13 Better in cold dry weather
1E14 Worse in summer (whole season)
1E15 Better in summer (whole season)
1E16 Worse in winter (whole season)
1E17 Better in winter (whole season)
1E18 Worse premenstrually
1E19 Worse during pregnancy
1E20 Better during pregnancy
1E21 Worse post-partum
1E22 Better post-partum
1E23 Worse post-menopause
1E24 Better post-menopause
1E25 Has grown worse with age
1E26 Has grown better with age
1ET1 (Text) Describe how pulling varies as life situations change
1ET2 (Text) Describe climate(s) when pulling is worst
1ET3 (Text) Describe climate(s) when pulling is best
1ET4 (Text) Describe any other noticeable changes in pulling
1ET5 (Text) Other comments on temporal and environmental effects
Subpart 1F: Dietary Effects
This subpart asks you to measure the extent that your TTM varies under
various changes in diet. It is likely that for some of these questions
you will not have noticed any relationship at all; in that case, leave
the question blank. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1F01 Worse due to sugar
1F02 Worse due to aspartame (Nutrisweet, diet drinks, etc.)
1F03 Worse due to caffeine
1F04 Worse due to alcohol
1F05 Worse due to tobacco
1F06 Worse due to chocolate
1F07 Worse due to milk (or butter, yogurt, cheese, etc.)
1F08 Worse due to grains
1F09 Worse due to legumes (beans, peanuts, licorice, etc.)
1F10 Worse due to forms of cholesterol (eggs, "rich" food, etc.)
1F11 Worse due to nightshades (tomato, potato, eggplant, pepper)
1F12 Worse due to nuts (not including peanuts)
1F13 Worse due to seeds (sunflower, etc.)
1F14 Better due to garlic
1F15 Better due to unsweetened tea
1F16 Better due to bromelains (pineapple, kiwi fruit, etc.):
1F17 Better due to B vitamins
1FT1 (Text) Describe other foods that are harmful
1FT2 (Text) Describe other foods that are helpful
1FT3 (Text) Describe effectiveness and duration of any diets
1FT4 (Text) Other comments on dietary effects
PART 2: OTHER RELATED BEHAVIORS
Subpart 2A: Other Skin Irritations
This subpart asks you to measure the extent to which you experience or
have experienced the following skin irritations and disorders. Use the
following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
2A01 Pimples around hair follicles
2A02 Dandruff
2A03 Acne
2A04 Blackheads or whiteheads
2A05 Pimples on eyelids (sty)
2A06 Dry, burning, or itchy eyes or eyelids
2A07 Crusty eyes on awakening
2A08 Cold sores (herpes simplex)
2A09 Canker sores (aphthous ulcers)
2A10 Chapped lips
2A11 Body odor
2A12 Hives
2A13 Eczema
2A14 Vitiligo
2A15 Psoriasis
2A16 Seborrheic dermatitis
2A17 Recurrent staph infections
2A18 Fungus attacks (athlete's foot, tinea versicolor, etc.)
2A19 "The Itch" or "The Bites" (needle-like sharp stings on body)
2AT1 (Text) Describe other skin conditions
2AT2 (Text) Other comments on other skin irritations
Subpart 2B: Responses to Skin Irritations
This subpart asks you to measure the extent to which you respond to skin
irritations by the strategies enumerated. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
2B01 Squeeze pimples, black/whiteheads, or clogged pores
2B02 Bite lips, cheeks, or tongue
2B03 Pick lip skin
2B04 Pick nose
2B05 Eat picked nasal mucus
2B06 Q-Tip ears
2B07 Smell or eat ear wax
2B08 Pick at skin, cuticles, or callouses
2B09 Clip skin, cuticles, or callouses with clippers or scissors
2B10 Eat picked skin, cuticles, or callouses
2B11 Bite nails
2B12 Chew on bitten off nails
2B13 Suck thumb
2B14 Lick and smell back of hand
2B15 Pick at scabs
2B16 Eat picked scabs
2B17 Cut skin
2B18 Burn skin
2B19 "Scratch and sniff" armpits or groin
2B20 "Scratch and sniff" navel
2B21 Crack knuckles or joints
2BT1 (Text) Describe any other area or thing picked, smelled, or eaten
2BT2 (Text) Other comments on responses to skin irritations
Subpart 2C: Related Non-Skin Disorders
This subpart asks you to measure the extent you experience or have
experienced these non-skin disorders. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
2C01 Depression
2C02 Anxiety disorder
2C03 Panic disorder (PD)
2C04 Seasonal Affective Disorder (SAD)
2C05 Chronic Fatigue Syndrome (CFS)
2C06 Insomnia
2C07 Attention Deficit Hyperactivity Disorder (ADHD)
2C08 Personality disorder (as diagnosed by a professional)
2C09 Migraine headaches
2C10 Obsessive-Compulsive Disorder (OCD)
2C11 Tourette's syndrome (TS)
2C12 Oral tics
2C13 Stuttering, stammering, or difficulty in word retrieval
2C14 Dyslexia
2C15 Anorexia or bulimia
2C16 Binge eating
2C17 Morbid obesity
2C18 Bruxism (teeth grinding)
2C19 Alcoholism
2C20 Substance abuse
2C21 Hypothyroidism
2C22 Anemia
2C23 Irritable Bowel Syndrome (IBS)
2C24 Bed wetting
2CT1 (Text) Describe any autoimmune disorders (Addison's, Crohn's, Grave's,
Insulin-dependent diabetes mellitus, Lupus, Multiple sclerosis,
Myasthenia gravis, Pernicious anemia, etc.)
2CT2 (Text) Describe any other related chronic condition
2CT3 (Text) Describe how the above conditions affect pulling
2CT4 (Text) Other comments on related disorders
PART 3: INTERVENTIONS
Subpart 3A: Disguises Used
This subpart asks you to measure the extent to which you use or have
used the following disguises. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
3A01 Wig
3A02 Hairpiece
3A03 Hair extensions
3A04 Colored hair spray
3A05 Head coverings (hats, scarves, etc.)
3A06 Shaved head
3A07 Eyebrow pencil
3A08 False eyelashes
3A09 Eyeshadow
3A10 Mascara
3A11 Eyeliner
3A12 Sunglasses
3AT1 (Text) Describe how use of disguises affected pulling
3AT2 (Text) Other comments on disguises used
Subpart 3B: Effectiveness of Therapy
This subpart asks you rate the benefit you have received, on a
continuing basis, from the following therapies. If you have not given
the therapy a fair trial, leave the question blank. Use the following
scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
3B01 Medication, antidepressant: Anafranil
3B02 Medication, antidepressant: Buspar
3B03 Medication, antidepressant: Luvox
3B04 Medication, antidepressant: Paxil
3B05 Medication, antidepressant: Prozac
3B06 Medication, antidepressant: Zoloft
3B07 Medication, systemic antihistamine (Claritin, etc.)
3B08 Medication, systemic antifungal (Nystatin, etc.)
3B09 Allergy desensitization ("allergy shots")
3B10 Behavioral therapy
3B11 Immune system therapy
3B12 Alternative: Acupuncture
3B13 Alternative: Ayurveda
3B14 Alternative: Bodywork
3B15 Alternative: Homeopathy
3B16 Alternative: Hypnotherapy
3B17 Altermative: Rolfing
3B18 Alternative: Yoga
3BT1 (Text) Describe the side effects of any medication
3BT2 (Text) Describe the kind of behavioral therapy
3BT3 (Text) Describe any other therapies pursued fairly
3BT4 (Text) Other comments on effectiveness of therapy
Subpart 3C: Attaining and Maintaining Remission
This subpart asks you measure the extent to which the over-the-counter
medications and the self-help interventions below have been responsible
for decreased pulling or remissions. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
3C01 OTC medication: dandruff shampoos (Zincon or Head & Shoulders, Denorex,
Selsun Blue, etc.)
3C02 OTC medication: steroids (hydrocortizone compounds, etc.)
3C03 OTC medication: anti-itch compounds (Listerine, Gold Bond powder, etc.)
3C04 OTC medication: anesthetics (benzocaine compounds, etc.)
3C05 OTC medication: antifungals (Mycelex, Micatine, etc.)
3C06 OTC medication: antihistamines (Contac, Sudafed, etc.)
3C07 Skin exposure: sunlight or ultraviolet light (UV)
3C08 Skin exposure: long hot showers
3C09 Skin exposure: ice cubes on hot spots
3C10 Devices: "toys" to keep hands occupied (worry beads, putty, etc.)
3C11 Devices: hand coverings (gloves, rubber bands, creams, etc.)
3C12 Devices: head coverings (caps, lotions, etc.)
3C13 Activities: engaging deliberately in work or play involving the hands
3C14 Activities: engaging deliberately in social events with lots of people
3C15 Activities: exercise
3C16 Activities: leading a busy life
3C17 Body/Mind: diet
3C18 Body/Mind: meditation
3C19 Body/Mind: being free of depression
3C20 Body/MInd: nothing ("One day it just went away")
3C21 Average length of remission [give months]
3CT1 (Text) Give details of any of the above that were helpful (e.g. which
shampoo, which toys, which diet, which type of exercise, etc.)
3CT2 (Text) Describe why the helpful ones worked
3CT3 (Text) Describe the color, texture, and amount of that hair that regrew,
and how long it took to do so
3CT4 (Text) Describe the cause of the end of the remissions
3CT5 (Text) Other comments on attaining and maintaining remission
PART 4: PERSONAL INFORMATION
Subpart 4A: Wellness Issues
This subpart asks you to survey medical, hygiene, and related issues.
Use the following scale unless specified:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4A01 Amount of worry or stress
4A02 Amount of loneliness
4A03 Degree to which a pet cat or dog licks or bites its fur or skin
4A04 Taking birth control pills [0=no, 1=yes]
4A05 Taking estrogen replacement therapy [0=no, 1=yes]
4A06 Coffee use [give cups/day]
4A06 Tea and/or caffeinated soft drink use [give cups/day]
4A07 Tobacco use [give packs/day]
4A08 Exercise frequency [give hours/week]
4A09 Bathing and hair washing frequency [give times/week]
4AT1 (Text) Describe type of shampoo used
4AT2 (Text) Types and frequency of anti-inflammatory medication
4AT3 (Text) Other comments on wellness issues
Subpart 4B: Allergies
This subpart asks you to measure the extent of your known allergies to
various substances. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4B01 Molds
4B02 Penicillin
4B03 Sulfa drugs
4B04 Animals or animal dander
4B05 Dust or dust mites
4B06 Pollen
4B07 Grasses or grains (wheat, corn, etc.)
4B08 Nightshades (tomato, potato, eggplant, pepper, tobacco)
4B09 Nitrates
4BT1 (Text) Describe other known allergies
4BT2 (Text) Other comments on allergies
Subpart 4C: Family Data
This subpart asks you about your relatives, your relations with them,
and histories of TTM. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4C01 Severity of TTM of mother
4C02 Severity of TTM of father
4C03 Severity of TTM of sibling with most severe TTM
4C04 Severity of TTM of sibling with least severe TTM
4C05 Closeness to mother
4C06 Closeness to father
4C07 Closeness to sibling with most severe TTM
4C08 Closeness to sibling with least severe TTM
4C09 Quality of social adjustment during school years
4C10 Quality of social adjustment during adult years
4CT1 (Text) Describe severity of TTM of other relatives with TTM
4CT2 (Text) Describe any other related behaviors of other relatives
4CT3 (Text) Other comments on family data
Subpart 4D: Personal Questions
This subpart asks you personal information. Give the type of
information requested; if not specified, use the scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4D01 Oiliness of hair
4D02 Curliness of hair
4D03 Fineness of individual hairs
4D04 Coarseness of individual hairs
4D05 Fullness of head hair in natural ("unpulled") state
4D06 Fullness of eyelashes in natural ("unpulled") state
4D07 Fullness of eyebrows in natural ("unpulled") state
4D08 Fullness of head hair presently
4D09 Fullness of eyelashes presently
4D10 Fullness of eyebrows presently
4D11 Length of head hair presently
4D12 Amount of grey or white hair
4D13 Amount of male pattern baldness
4D14 How much you like your hair
4D15 How much you hate your hair
4D16 Sex [0=female, 1=male]
4D17 Age [give years]
4D18 Prematurity at birth [give weeks]
4D19 Length of breastfeeding [give months]
4D20 Age at onset of TTM [give years]
4D21 Handedness [1=left, 2=right, 3=both]
4D22 Resting body temperature [0=very cold to 4=very hot]
4D23 Teeth with mercury amalgam fillings [give number]
4D24 Cholesterol level
4D25 Blood pressure, systolic ("upper" number)
4D26 Blood pressure, diastolic ("lower" number)
4D27 Myer-Briggs Type Indicator, slot 1 [0=E, 1=I]
4D28 Myer-Briggs Type Indicator, slot 2 [0=S, 1=N]
4D29 Myer-Briggs Type Indicator, slot 3 [0=F, 1=T]
4D30 Myer-Briggs Type Indicator, slot 4 [0=P, 1=J]
4D31 Achievement striving [0=very under- to 4=very over-]
4DT1 (Text) Describe natural hair color (blond, red, brunette, black, etc.)
4DT2 (Text) Describe ethnic background
4DT3 (Text) Describe climate living in
4BT4 (Text) Describe any precipitating events at onset (comment by parent
or friend, sight of pulled hair, someone pulling your hair, being
shown how to make a wish on an eyelash, etc.)
4BT5 (Text) Describe any events that appear to have increased pulling
dramatically (changes in non-TTM medication, quitting smoking, major
illness, illness or death of of family member, etc.)
4BT6 (Text) Describe your feelings about your hair (what you like, what you
dislike, how you wish it were different, etc.)
4DT7 (Text) Other comments on personal questions
PART 5: OTHER ISSUES
5AT1 (Text) Other comments on issues not categorized above
END OF SURVEY
PLEASE DO NOT SEND ANSWERS!
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THE GRASS-ROOTS TTM SURVEY (aka THE HALLOPOLL)
PART 1: PULLING BEHAVIORS
Subpart 1A: Pre-Pulling Behaviors
This subpart asks you about your experiences *prior* to actually pulling
your hair. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1A01 Anxiety, agitation, or increasing tension
1A02 Aggravation, irritation, or anger
1A03 Increase in non-TTM obsessive-compulsive behaviors
1A04 Boredom, mental idling, or mental preoccupation
1A05 Localized itch or "hair feeling out of place"
1A06 Touching, massaging, or scratching of skin nearby
1A07 Stroking, tugging, or twisting of hairs
1A08 Deliberate "hunting" for "certain" hairs
1A09 Exploration with tools: tweezers, etc.
1AT1 (Text) Describe the "certain" hairs that are hunted for
1AT2 (Text) Other comments on pre-pulling behaviors
Subpart 1B: Areas Pulled
This subpart asks you to measure the extent of your pulling on various
parts of your (or someone else's) body. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
In general, these questions ask about the *frequency* of a behavior.
1B01 Crown or top of head
1B02 Sides of head
1B03 Back of Head
1B04 Eyebrows
1B05 Eyelashes
1B06 Nasal hairs
1B07 Chin, neck, or beard
1B08 Arms or hands
1B09 Armpits
1B10 Chest, breasts, or nipples
1B11 Pubic areas
1B12 Anal areas
1B13 Legs or feet
1B14 Other areas of your body
1B15 Areas of another person's body
1B16 Areas of a pet's body
1BT1 (Text) Describe these other areas of your body
1BT2 (Text) Describe the areas of some other's body
1BT3 (Text) Other comments on areas pulled
Subpart 1C: Pulling Behaviors Themselves
This subpart asks you about your experiences *during* the actual pulling
of your hair. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
In general, these questions ask about the *frequency* of a behavior.
[But note that some ask for other numbers.]
1C01 Is rewarding
1C02 Is soothing, peaceful
1C03 First is soothing, but then becomes an irritating hot spot
1C04 Causes physical pain
1C05 Is during a sedentary activity (driving, reading, watching TV, talking
on phone, etc.)
1C06 Is during a stress situation (angry, depressed, feeling fat, on
deadline, worry, etc.)
1C07 Is in public
1C08 Is solitary
1C09 Is in front of a mirror
1C10 Done with tools (tweezers, etc.)
1C11 Done on individual hairs
1C12 Done in clumps
1C13 Amount of affected area pulled
1C14 Average time spent pulling [give hours per day]
1C15 Hand used to pull with [1=left, 2=right, 3=both]
1CT1 (Text) Describe any other feelings during pulling
1CT2 (Text) Describe usual pulling place (bed, bath, car, etc.)
1CT3 (Text) Other comments on pulling behaviors themselves
Subpart 1D: Post-Pulling Behaviors
This subpart asks you about your experiences *after* an *individual*
pull of a hair; a few then ask about a session. Use the following
scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1D01 Feeling is gratification, release, or relief
1D02 Feeling is gratification, release, or relief, particularly if the root
pulled out is fat
1D03 Feeling is frustration
1D04 Feeling is compulsion for more
1D05 Feeling is compulsion for more, particularly if the hair breaks or there
is no root
1D06 How likely is hair played with the fingers (curled, twirled, etc.)
1D07 How likely is hair smelled
1D08 How likely is hair touched to lip or face
1D09 How likely is hair pulled through teeth
1D10 How likely is root pulled off
1D11 How likely is root eaten
1D12 How likely is root used as a tiny paintbrush
1D13 How likely is entire hair eaten
1D14 How likely is hair dismembered
1D15 During a pulling session, how likely are pulled hairs "organized" (lined
up, counted, stuck to things)
1D16 During a pulling session, how likely do feelings become negative (shame,
anger, frustration) but pulling goes on
1D17 After a pulling session is over, how likely do feelings become or stay
negative (shame, anger, frustration)
1DT1 (Text) Describe what usually terminates an individual pull (what makes a
hair be "used up")
1DT2 (Text) Describe what usually terminates a pulling session
1DT3 (Text) Describe any other pulling-related rituals
1DT4 (Text) Other comments on post-pulling behaviors
Subpart 1E: Temporal and Environmental Effects
This subpart asks you to measure the extent that your TTM varies under
various circumstances. It is likely that for some of these questions
you will not have noticed any relationship at all; in that case, leave
the question blank. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1E01 Worse when sad or depressed
1E02 Better when happy
1E03 Worse during an illness
1E04 Worse after an illness
1E05 Worse after an infection
1E06 Worse after taking antibiotics
1E07 Worse when feeling chilled
1E08 Worse in the evening
1E09 Worse after lack of sleep
1E10 Worse in hot humid weather
1E11 Better in hot humid weather
1E12 Worse in cold dry weather
1E13 Better in cold dry weather
1E14 Worse in summer (whole season)
1E15 Better in summer (whole season)
1E16 Worse in winter (whole season)
1E17 Better in winter (whole season)
1E18 Worse premenstrually
1E19 Worse during pregnancy
1E20 Better during pregnancy
1E21 Worse post-partum
1E22 Better post-partum
1E23 Worse post-menopause
1E24 Better post-menopause
1E25 Has grown worse with age
1E26 Has grown better with age
1ET1 (Text) Describe how pulling varies as life situations change
1ET2 (Text) Describe climate(s) when pulling is worst
1ET3 (Text) Describe climate(s) when pulling is best
1ET4 (Text) Describe any other noticeable changes in pulling
1ET5 (Text) Other comments on temporal and environmental effects
Subpart 1F: Dietary Effects
This subpart asks you to measure the extent that your TTM varies under
various changes in diet. It is likely that for some of these questions
you will not have noticed any relationship at all; in that case, leave
the question blank. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
1F01 Worse due to sugar
1F02 Worse due to aspartame (Nutrisweet, diet drinks, etc.)
1F03 Worse due to caffeine
1F04 Worse due to alcohol
1F05 Worse due to tobacco
1F06 Worse due to chocolate
1F07 Worse due to milk (or butter, yogurt, cheese, etc.)
1F08 Worse due to grains
1F09 Worse due to legumes (beans, peanuts, licorice, etc.)
1F10 Worse due to forms of cholesterol (eggs, "rich" food, etc.)
1F11 Worse due to nightshades (tomato, potato, eggplant, pepper)
1F12 Worse due to nuts (not including peanuts)
1F13 Worse due to seeds (sunflower, etc.)
1F14 Better due to garlic
1F15 Better due to unsweetened tea
1F16 Better due to bromelains (pineapple, kiwi fruit, etc.):
1F17 Better due to B vitamins
1FT1 (Text) Describe other foods that are harmful
1FT2 (Text) Describe other foods that are helpful
1FT3 (Text) Describe effectiveness and duration of any diets
1FT4 (Text) Other comments on dietary effects
PART 2: OTHER RELATED BEHAVIORS
Subpart 2A: Other Skin Irritations
This subpart asks you to measure the extent to which you experience or
have experienced the following skin irritations and disorders. Use the
following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
2A01 Pimples around hair follicles
2A02 Dandruff
2A03 Acne
2A04 Blackheads or whiteheads
2A05 Pimples on eyelids (sty)
2A06 Dry, burning, or itchy eyes or eyelids
2A07 Crusty eyes on awakening
2A08 Cold sores (herpes simplex)
2A09 Canker sores (aphthous ulcers)
2A10 Chapped lips
2A11 Body odor
2A12 Hives
2A13 Eczema
2A14 Vitiligo
2A15 Psoriasis
2A16 Seborrheic dermatitis
2A17 Recurrent staph infections
2A18 Fungus attacks (athlete's foot, tinea versicolor, etc.)
2A19 "The Itch" or "The Bites" (needle-like sharp stings on body)
2AT1 (Text) Describe other skin conditions
2AT2 (Text) Other comments on other skin irritations
Subpart 2B: Responses to Skin Irritations
This subpart asks you to measure the extent to which you respond to skin
irritations by the strategies enumerated. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
2B01 Squeeze pimples, black/whiteheads, or clogged pores
2B02 Bite lips, cheeks, or tongue
2B03 Pick lip skin
2B04 Pick nose
2B05 Eat picked nasal mucus
2B06 Q-Tip ears
2B07 Smell or eat ear wax
2B08 Pick at skin, cuticles, or callouses
2B09 Clip skin, cuticles, or callouses with clippers or scissors
2B10 Eat picked skin, cuticles, or callouses
2B11 Bite nails
2B12 Chew on bitten off nails
2B13 Suck thumb
2B14 Lick and smell back of hand
2B15 Pick at scabs
2B16 Eat picked scabs
2B17 Cut skin
2B18 Burn skin
2B19 "Scratch and sniff" armpits or groin
2B20 "Scratch and sniff" navel
2B21 Crack knuckles or joints
2BT1 (Text) Describe any other area or thing picked, smelled, or eaten
2BT2 (Text) Other comments on responses to skin irritations
Subpart 2C: Related Non-Skin Disorders
This subpart asks you to measure the extent you experience or have
experienced these non-skin disorders. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
2C01 Depression
2C02 Anxiety disorder
2C03 Panic disorder (PD)
2C04 Seasonal Affective Disorder (SAD)
2C05 Chronic Fatigue Syndrome (CFS)
2C06 Insomnia
2C07 Attention Deficit Hyperactivity Disorder (ADHD)
2C08 Personality disorder (as diagnosed by a professional)
2C09 Migraine headaches
2C10 Obsessive-Compulsive Disorder (OCD)
2C11 Tourette's syndrome (TS)
2C12 Oral tics
2C13 Stuttering, stammering, or difficulty in word retrieval
2C14 Dyslexia
2C15 Anorexia or bulimia
2C16 Binge eating
2C17 Morbid obesity
2C18 Bruxism (teeth grinding)
2C19 Alcoholism
2C20 Substance abuse
2C21 Hypothyroidism
2C22 Anemia
2C23 Irritable Bowel Syndrome (IBS)
2C24 Bed wetting
2CT1 (Text) Describe any autoimmune disorders (Addison's, Crohn's, Grave's,
Insulin-dependent diabetes mellitus, Lupus, Multiple sclerosis,
Myasthenia gravis, Pernicious anemia, etc.)
2CT2 (Text) Describe any other related chronic condition
2CT3 (Text) Describe how the above conditions affect pulling
2CT4 (Text) Other comments on related disorders
PART 3: INTERVENTIONS
Subpart 3A: Disguises Used
This subpart asks you to measure the extent to which you use or have
used the following disguises. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
3A01 Wig
3A02 Hairpiece
3A03 Hair extensions
3A04 Colored hair spray
3A05 Head coverings (hats, scarves, etc.)
3A06 Shaved head
3A07 Eyebrow pencil
3A08 False eyelashes
3A09 Eyeshadow
3A10 Mascara
3A11 Eyeliner
3A12 Sunglasses
3AT1 (Text) Describe how use of disguises affected pulling
3AT2 (Text) Other comments on disguises used
Subpart 3B: Effectiveness of Therapy
This subpart asks you rate the benefit you have received, on a
continuing basis, from the following therapies. If you have not given
the therapy a fair trial, leave the question blank. Use the following
scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
3B01 Medication, antidepressant: Anafranil
3B02 Medication, antidepressant: Buspar
3B03 Medication, antidepressant: Luvox
3B04 Medication, antidepressant: Paxil
3B05 Medication, antidepressant: Prozac
3B06 Medication, antidepressant: Zoloft
3B07 Medication, systemic antihistamine (Claritin, etc.)
3B08 Medication, systemic antifungal (Nystatin, etc.)
3B09 Allergy desensitization ("allergy shots")
3B10 Behavioral therapy
3B11 Immune system therapy
3B12 Alternative: Acupuncture
3B13 Alternative: Ayurveda
3B14 Alternative: Bodywork
3B15 Alternative: Homeopathy
3B16 Alternative: Hypnotherapy
3B17 Altermative: Rolfing
3B18 Alternative: Yoga
3BT1 (Text) Describe the side effects of any medication
3BT2 (Text) Describe the kind of behavioral therapy
3BT3 (Text) Describe any other therapies pursued fairly
3BT4 (Text) Other comments on effectiveness of therapy
Subpart 3C: Attaining and Maintaining Remission
This subpart asks you measure the extent to which the over-the-counter
medications and the self-help interventions below have been responsible
for decreased pulling or remissions. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
3C01 OTC medication: dandruff shampoos (Zincon or Head & Shoulders, Denorex,
Selsun Blue, etc.)
3C02 OTC medication: steroids (hydrocortizone compounds, etc.)
3C03 OTC medication: anti-itch compounds (Listerine, Gold Bond powder, etc.)
3C04 OTC medication: anesthetics (benzocaine compounds, etc.)
3C05 OTC medication: antifungals (Mycelex, Micatine, etc.)
3C06 OTC medication: antihistamines (Contac, Sudafed, etc.)
3C07 Skin exposure: sunlight or ultraviolet light (UV)
3C08 Skin exposure: long hot showers
3C09 Skin exposure: ice cubes on hot spots
3C10 Devices: "toys" to keep hands occupied (worry beads, putty, etc.)
3C11 Devices: hand coverings (gloves, rubber bands, creams, etc.)
3C12 Devices: head coverings (caps, lotions, etc.)
3C13 Activities: engaging deliberately in work or play involving the hands
3C14 Activities: engaging deliberately in social events with lots of people
3C15 Activities: exercise
3C16 Activities: leading a busy life
3C17 Body/Mind: diet
3C18 Body/Mind: meditation
3C19 Body/Mind: being free of depression
3C20 Body/MInd: nothing ("One day it just went away")
3C21 Average length of remission [give months]
3CT1 (Text) Give details of any of the above that were helpful (e.g. which
shampoo, which toys, which diet, which type of exercise, etc.)
3CT2 (Text) Describe why the helpful ones worked
3CT3 (Text) Describe the color, texture, and amount of that hair that regrew,
and how long it took to do so
3CT4 (Text) Describe the cause of the end of the remissions
3CT5 (Text) Other comments on attaining and maintaining remission
PART 4: PERSONAL INFORMATION
Subpart 4A: Wellness Issues
This subpart asks you to survey medical, hygiene, and related issues.
Use the following scale unless specified:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4A01 Amount of worry or stress
4A02 Amount of loneliness
4A03 Degree to which a pet cat or dog licks or bites its fur or skin
4A04 Taking birth control pills [0=no, 1=yes]
4A05 Taking estrogen replacement therapy [0=no, 1=yes]
4A06 Coffee use [give cups/day]
4A06 Tea and/or caffeinated soft drink use [give cups/day]
4A07 Tobacco use [give packs/day]
4A08 Exercise frequency [give hours/week]
4A09 Bathing and hair washing frequency [give times/week]
4AT1 (Text) Describe type of shampoo used
4AT2 (Text) Types and frequency of anti-inflammatory medication
4AT3 (Text) Other comments on wellness issues
Subpart 4B: Allergies
This subpart asks you to measure the extent of your known allergies to
various substances. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4B01 Molds
4B02 Penicillin
4B03 Sulfa drugs
4B04 Animals or animal dander
4B05 Dust or dust mites
4B06 Pollen
4B07 Grasses or grains (wheat, corn, etc.)
4B08 Nightshades (tomato, potato, eggplant, pepper, tobacco)
4B09 Nitrates
4BT1 (Text) Describe other known allergies
4BT2 (Text) Other comments on allergies
Subpart 4C: Family Data
This subpart asks you about your relatives, your relations with them,
and histories of TTM. Use the following scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4C01 Severity of TTM of mother
4C02 Severity of TTM of father
4C03 Severity of TTM of sibling with most severe TTM
4C04 Severity of TTM of sibling with least severe TTM
4C05 Closeness to mother
4C06 Closeness to father
4C07 Closeness to sibling with most severe TTM
4C08 Closeness to sibling with least severe TTM
4C09 Quality of social adjustment during school years
4C10 Quality of social adjustment during adult years
4CT1 (Text) Describe severity of TTM of other relatives with TTM
4CT2 (Text) Describe any other related behaviors of other relatives
4CT3 (Text) Other comments on family data
Subpart 4D: Personal Questions
This subpart asks you personal information. Give the type of
information requested; if not specified, use the scale:
0=none, 1=slight, 2=moderate, 3=considerable, 4=extreme.
4D01 Oiliness of hair
4D02 Curliness of hair
4D03 Fineness of individual hairs
4D04 Coarseness of individual hairs
4D05 Fullness of head hair in natural ("unpulled") state
4D06 Fullness of eyelashes in natural ("unpulled") state
4D07 Fullness of eyebrows in natural ("unpulled") state
4D08 Fullness of head hair presently
4D09 Fullness of eyelashes presently
4D10 Fullness of eyebrows presently
4D11 Length of head hair presently
4D12 Amount of grey or white hair
4D13 Amount of male pattern baldness
4D14 How much you like your hair
4D15 How much you hate your hair
4D16 Sex [0=female, 1=male]
4D17 Age [give years]
4D18 Prematurity at birth [give weeks]
4D19 Length of breastfeeding [give months]
4D20 Age at onset of TTM [give years]
4D21 Handedness [1=left, 2=right, 3=both]
4D22 Resting body temperature [0=very cold to 4=very hot]
4D23 Teeth with mercury amalgam fillings [give number]
4D24 Cholesterol level
4D25 Blood pressure, systolic ("upper" number)
4D26 Blood pressure, diastolic ("lower" number)
4D27 Myer-Briggs Type Indicator, slot 1 [0=E, 1=I]
4D28 Myer-Briggs Type Indicator, slot 2 [0=S, 1=N]
4D29 Myer-Briggs Type Indicator, slot 3 [0=F, 1=T]
4D30 Myer-Briggs Type Indicator, slot 4 [0=P, 1=J]
4D31 Achievement striving [0=very under- to 4=very over-]
4DT1 (Text) Describe natural hair color (blond, red, brunette, black, etc.)
4DT2 (Text) Describe ethnic background
4DT3 (Text) Describe climate living in
4BT4 (Text) Describe any precipitating events at onset (comment by parent
or friend, sight of pulled hair, someone pulling your hair, being
shown how to make a wish on an eyelash, etc.)
4BT5 (Text) Describe any events that appear to have increased pulling
dramatically (changes in non-TTM medication, quitting smoking, major
illness, illness or death of of family member, etc.)
4BT6 (Text) Describe your feelings about your hair (what you like, what you
dislike, how you wish it were different, etc.)
4DT7 (Text) Other comments on personal questions
PART 5: OTHER ISSUES
5AT1 (Text) Other comments on issues not categorized above
END OF SURVEY
PLEASE DO NOT SEND ANSWERS!PLEASE DO NOT SEND ANSWERS!PLEASE DO NOT SEND
ANSWERS!PLEASE DO NOT SEND ANSWERS!PLEASE DO NOT SEND ANSWERS!PLEASE DO NOT SEND
ANSWERS!PLEASE DO NOT SEND ANSWERS!PLEASE DO NOT SEND ANSWERS!PLEASE DO NOT SEND
ANSWERS!PLEASE DO NOT SEND ANSWERS!