Trichotillomania and Dermatillomania (Body Focused Repetitive Behaviors)
Body-focused repetitive behaviors (BFRBs) is when a person causes harm or damage to themselves or their appearance. A form of BFRB is trichotillomania (trich), a compulsive hair pulling disorder. Compulsive hair pulling can end in bald patches or hair loss. Hair is often pulled from spots that are easily reached, therefore easily noticeable. After pulling the hair an individual may eat or play with their hair. Individuals with trich experience embarrassment and shame and try to hide their hair loss with wigs, clothing, or makeup. Individuals may abstain from activities that reveal their hair loss such as going to hairdressers, being outside when it’s windy, or standing next to people who are taller than them. Despite repeated attempts to decrease or stop pulling, the person is unable to do so. Roughly 1% to 2% of the general population suffers from hair-pulling disorder, and females are 10 times more likely to be affected than males.
There is also dermatillomania, also called Excoriation, a compulsive skin picking disorder. This disorder involves excessive skin picking such as picking at blemishes, scabs, or scratching at skin. The goal for the individual is to achieve “smooth” skin by accelerating the healing process.
Forms of BFRBs:
- Skin picking
- Compulsive nail biting
- Cheek biting
- Nose picking
- Hair pulling (scalp, eyebrows or lashes, leg or arm hair, pubic region)
- Or a combo of these
To treat a BFRB we must first define why the individual is pulling or picking and create a customized plan of cognitive and behavioral strategies. Eventually these strategies will replace the BFRB with more adaptive behaviors. The goal is for an individual to no longer experience shame or embarrassment because of their picking or pulling but also cease the behavior of BFRBs that create a physical, emotional cognitive cycle.