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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.
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* Indicates required question
Email
*
Your email
What time is it?
*
Time
:
AM
PM
How much time did I spend doing the BFRB?
*
1 minute
5 minutes
10 minutes
15 minutes
20+ minutes
Just an urge
Where am I currently? (room, kitchen, school, work, etc)
*
Your answer
How aware am I that I am/was doing the BFRB?
*
Low awareness
Medium awareness
High awareness
What am I doing right now? Reading, TV, games, etc
*
Your answer
EMOTIONS
What is my urge to do the BFRB?
*
Low Urge
0
1
2
3
4
5
6
7
8
9
10
High Urge
What am I feeling right now?
*
Bored
Anxious
Excited
Depressed
Lonely
Happy
Other:
Required
THOUGHTS
What thoughts am I having right now?
*
Your answer
SENSATIONS
Do I feel anything in my body that signals me to do the BFRB? (Itch, heartbeat, tingling, etc)
*
Your answer
Think back to any detail of how the BFRB started. Explain below:
Your answer
A copy of your responses will be emailed to the address you provided.
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