Privacy: This website will NEVER divulge your E-mail address to any other people or organisation without your permission.

We will not compromise your privacy in any way

Name E-mail address

Sex What age did you start picking?

What usually triggers a picking spree for you?

What usually helps you to stop picking?

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

Please tick areas of most concern. Select as many options as apply to you.

forehead nose face-left chin
scalp chest pubic region hands and/or feet
arms legs pets other people
  ears neck  

Was your father present when you were growing up?

Did the start of your picking coincide with your parents' divorce or separation?

Do you have a difficult relationship with your parent(s)

Are you very self-critical

Were you :

Emotionally abused as a child
Physically abused as a child
Sexually abused as a child

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


Have you ever been prescribed medication for 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.

Which prescribed skin creams have you used to ease your skin? Please name the brands and comment on how successful it was.

Which over the counter creams or lotions have you used to calm your skin flare-ups? Please name the brands and comment on how helpful it was.

Doctor's approach to skin picking?

Were you hyperactive as a child

Do you have any learning difficulties or memory problems?

Have you ever been diagnosed as having any other disorder or condition? If so, which?

Do you have a partner/spouse

How have previous partners responded to your dermatillomania.

Did/does dermatillomania affect your ability to interact and to find a partner?

Do you ever stay in because you feel you shouldn't be seen in public with dermatillomania?

Approximately how much money per month do you spend on skin related purchases?


If you found this site through a search engine,
which search engine did you use and what did you type as your search criteria?

Are you a shy person?

Do you only pick in private?

Do you have the feeling that there is something dirty under your skin?

Do you have the feeling that there is something crawling under your skin?

Does your skin often itch when you cannot see any blemishes?

Did you have a security blanket or soft toy to which you were very attached as a child?

Are you very sensitive to textures on your skin?

Do you eat picked skin?

Other rituals(please explain)

Do you keep telling yourself you will stop in a minute.

Which websites do you find most helpful?
Please list one url per line.

What do you think of this website?

Would you like a derms buddy? Please check out the buddy rules. {em}By ticking this box you agree to your email address being passed to a potential buddy. We will not release it to anyone else.[/em]

Buddy Statement (state why you would be a good buddy & what type of person you would like as your buddy. (Ignore if you have not applied for a buddy)

Do you attend any dermatillomania related clinics or events?

Would you be interested in attending events etc.

What is your astrological star sign?

What is your date of birth?

Career (if any)

Do you find it easy to express anger?

Do you find it easy to get close to people?

May we contact you (this is likely to be very infrequent and we will not pass your data to anyone else) to advise of updates and events in the dermatillomania world? If so, should we use this e-mail address? Telephone number or address may be supplied if you prefer.

Are there any questions which you feel we have missed out and would like to see added to this questionnaire?

Please tick this box if you do not wish to receive an occasional (possibly bi-monthly) email with updates on derm treatments or if your email is not private and you don't want us to contact you. We do not spam and we won't pass your email address to anyone else.

NOTE ... IF YOU TICKED THE BOX ABOVE, YOU WON'T RECEIVE A BUDDY BECAUSE WE WON'T BE ABLE TO CONTACT YOU TO TELL YOU ABOUT IT. We also need your date (including year) of birth if you want a buddy, so we can match your ages).

Thank you so much for your time!
Welcome to the Site.

Press submit and wait. Please don't submit your questionnaire more than once. Thank you.


KIT TO STOP skin picking

kit to stop skin picking