CHILD SKIN PICKING TEST 1. How often do you feel the urge to pick your skin? No urges Mild, occasionally experience urges to skin pick, less than I hour/day Moderate, often experience urges to skin pick, 1-3 hours/day Severe, very often experience urges to skin pick, greater than 3 and up to 8 hours/day Extreme, constantly or almost always have an urge to skin pick 2. How intense or “strong” are the urges to pick your skin? Minimal or none Mild Moderate Severe Extreme 3. How much time do you spend picking your skin per day? None Mild, spend less than 1 hour per day picking my skin, or occasional skin picking. Moderate, spend 1-3 hours per day picking my skin, or frequent skin picking. Severe, spend more than 3 and up to 8 hours per day picking my skin, or very frequent skin picking. Extreme, spend more than 8 hours per day picking my skin, or near constant skin picking. 4. How much control do you have over your skin picking? To what degree can you stop yourself from picking? Complete control, I am always able to stop myself from picking. Much control, I am usually able to stop myself from picking. Some control, I am sometimes able to stop myself from picking. Little control, I am rarely able to stop myself from picking. No control, I am never able to stop myself from picking. 5. How much emotional distress (anxiety/worry, frustration, depression, hopelessness, or feelings of low self-esteem) do you experience from your skin picking? No emotional distress from picking. Mild, only slight emotional distress from my picking. I occasionally feel emotional distress because of my picking, but only to a small degree. Moderate, a fair amount of emotional distress from my picking. I often feel emotional distress because of my picking. Server, a large amount of emotional distress. I almost always feel emotional distress because of my picking. Extreme, constant emotional distress. I feel constant emotional distress and see no hope of this changing. 6. How much does your skin picking interfere with your social, work (or role functioning)? (If currently not working determine how much your performance would be affected if you were employed.) None Mild, slight interference with social or occupational activities by overall performance not impaired. Moderate, definite inference wit social or occupational performance, but still manageable. Severe, causes substantial impairment in social or occupational performance. Extreme, incapacitating. 7. Have you been avoiding doing anything, going any place, or being with anyone because of your skin picking? If yes, then how much do you avoid? None Mild, occasional avoidance in social or work settings. Moderate, frequent avoidance in social or work settings. Severe, very frequent avoidance in social or work settings. Extreme, avoid all social and work setting as a result of the skin picking/scratching. 8. How much skin damage do you currently have because of your skin picking? Only consider the damage produced by the behavior of picking. None, no skin damage from picking. Mild, slight damage in the form of small scabs, sores, scrapes, etc. Damage covers a very small area and no attempts are made to cover or treat the damage. Moderate, noticeable scars, scabs, or small open sores (less than 1 cm in diameter). Picking results in attempts to cover or treat the damage with in-home remedies (e.g., bandages, creams, ointments). That do not required the assistance of a physician. Severe, large scars, scabs or open sores (more than 1 cm in diameter), infected areas and/or noticeably disfigured skin. Picking results in extensive attempts to cover the damage and may require periodic treatment by a medical professional (e.g., prescription antibiotics, dermabrasion, etc.). Extreme, large open wounds or craters, frequent bleeding, large scarred areas. Damage may require extensive covering and medical intervention ( e.g., plastic surgery, stitches, hospitalization). Full Name Email Phone
