What they are
Body-Focused Repetitive Behaviors (BFRBs) are repetitive self-grooming habits that cause hair loss or skin damage. The two most common are:
- Trichotillomania (Hair-Pulling Disorder): recurrent pulling of hair (scalp, brows, lashes, beard, body hair).
- Excoriation (Skin-Picking) Disorder: recurrent picking at skin (face, arms, scalp, cuticles) causing lesions.
People often feel tension or urge before the behavior and relief afterward. BFRBs are not self-harm; they’re habit disorders—treatable with specialized therapy.
Common signs and symptoms
- Noticeable hair loss or skin lesions, scabs, scarring, infections
- Time lost to pulling/picking; difficulty stopping once started
- Triggers: boredom, stress, fatigue, screen time, mirrors; “automatic” pulling while reading/working
- Emotions: shame, embarrassment, hiding areas (hats, makeup), avoiding social activities or medical care
Why they happen
- Habit learning: the brain pairs certain internal states (stress, boredom) or cues (mirrors) with a behavior that brings brief relief
- Sensory factors: seeking certain tactile sensations (coarse hairs, irregularities)
- Cognitive/attention: zoning out, perfectionism about “irregular” hairs/skin
- Co-occurring issues: anxiety, depression, OCD traits, ADHD
What helps
- Gold-standard therapy: Habit Reversal Training (HRT) and Comprehensive Behavioral Treatment (ComB)
- Awareness training: track when/where urges happen; identify cues
- Competing responses: do an incompatible action for 1–2 minutes when the urge hits (clench fists, knit, stress ball, fidget ring)
- Stimulus control: cover mirrors, wear bandages/finger sleeves, keep hair tied, use hats or pimple patches; place tools out of reach
- Function-based plans: match strategies to sensory/feelings/thinking triggers
- Adjunctive therapies:
- Acceptance and Commitment Therapy (ACT) to ride out urges without acting
- CBT for perfectionism and stress
- Medications:
- No single “cure” pill; some benefit from N-acetylcysteine (NAC) supplements or SSRIs; discuss with a clinician
- Self-care and environment:
- Sleep regularity, breaks during screen time, reduce high-magnification mirror use
- Gentle skincare/haircare routines to reduce irritation and triggers
When to seek help now
- Bleeding, infections, significant hair loss/skin damage
- Distress, avoidance, or time loss (hours/week)
- Thoughts of self-harm or not wanting to live (seek urgent help)
How to talk to a clinician
- “I have recurrent [hair pulling/skin picking], especially when stressed or bored. I’d like HRT/ComB with stimulus control and to discuss options like NAC.”
Outlook
With HRT/ComB, many people reduce episodes and damage substantially. Expect practice and tweaks; lapses are common and manageable.
Resources for readers in the USA
- Immediate help: Call/text 988; Crisis Text Line text HOME to 741741
- Find care: Psychology Today (filter for BFRBs/HRT/ComB); FindTreatment.gov; NAMI HelpLine (nami.org/help)
- BFRB-specific: TLC Foundation for BFRBs: bfrb.org (education, providers, groups)
- Low-cost/community: Open Path Collective; Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Ask about in-network mental health benefits, telehealth, deductible, copay/coinsurance, prior authorization, out-of-network reimbursement, out-of-pocket max; note rep name/date/reference number
- Work/school supports: ADA accommodations if substantially limiting; EAP; campus counseling
- Urgent options besides ER: Mobile Crisis via 988 (where available), behavioral urgent care
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.