Skin Picking, Hair Pulling, & Other BFRBs
Skin picking (Excoriation Disorder) and hair pulling (Trichotillomania) are far more common than many people realize. In fact, they fall under a broader category known as Body-Focused Repetitive Behaviors (BFRBs). BFRBs include repetitive self-grooming behaviors such as picking, pulling, biting, or scraping the skin, hair, lips, cheeks, or nails. While these behaviors are often attempts to manage discomfort or stress, they can lead to physical injury and significant frustration—especially when repeated efforts to stop or reduce them don’t seem to work.
The good news is that BFRBs are treatable. With the right, evidence-based support, it is possible to build awareness, respond differently to urges, and reduce the impact these behaviors have on your life.
BFRBs can be “focused” or “unfocused”
Focused BFRBs
These are deliberate, conscious behaviors where the person is fully aware that they are engaging in the behavior. Focused BFRBs typically happen when a person feels a specific urge to act out the behavior, and they are often more intentional in nature.
Unfocused BFRBs
In contrast, unfocused BFRBs are more automatic or unconscious. The individual may not realize they're engaging in the behavior until they've already done it. These behaviors tend to happen during moments of stress, boredom, or daydreaming, and they often occur without the person’s active awareness or intention.
BFRBs are not considered self-harm.
Though these behaviors do cause harm to one's body, they are NOT considered self-harm. As opposed to self-harm behaviors, the purpose in BFRBs is not to cause damage but to regulate or soothe oneself. Physical damage is not an intended consequence.
Therapy can help manage BFRBs
In therapy, individuals can learn to recognize patterns and triggers related to their BFRBs and develop skills to respond to emotions in more supportive ways. Rather than reacting automatically, therapy helps increase awareness of internal cues, such as stress, boredom, or discomfort, so individuals can pause and choose a different response.
BFRBs are considered chronic, meaning symptoms often fluctuate over time. It’s common for urges or behaviors to intensify during periods of increased stress, including positive or “good” stress like vacations, life changes, or promotions.
Treatment for BFRBs typically draws from several evidence-based approaches, including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Habit Reversal Training (HRT), and Comprehensive Behavioral Treatment (ComB). When integrated, these approaches are referred to as Integrative Behavioral Therapy (IBT).
The overall goal of therapy is to help individuals better understand when and why the behavior occurs, build flexibility around urges, and develop a greater sense of choice and control.