Track Your BFRB Symptoms
Choose a time where you're noticing yourself doing the BFRB or you feel the URGE to do your BFRB.
Try to do this a few times a week so we can find some common patterns.
Sign in to Google to save your progress. Learn more
What time is it? *
Time
:
How much time did I spend doing the BFRB? *
Where am I currently? (room, kitchen, school, work, etc) *
How aware am I that I am/was doing the BFRB? *
What am I doing right now? Reading, TV, games, etc *
EMOTIONS
What is my urge to do the BFRB? *
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 do the BFRB? (Itch, heartbeat, tingling, etc) *
Think back to any detail of how the BFRB started. Explain below:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of OCD and Anxiety Counseling.

Does this form look suspicious? Report

Google Forms