5 Key Things You Need To Know About Hair Pulling (Trichotillomania) and Skin Picking Disorders

Hair pulling disorder (officially called Trichotillomania), nail biting disorder, and skin picking disorder (officially called Excoriation Disorder) fall into a category called Body Focused Repetitive Behaviors (BFRB’s). These disorders are confusing because the people struggling don’t want to be doing these behaviors. Learn about what these disorders are, how they impact people’s lives, and treatment that can make a a real difference.

-When I finished my call, I looked down and saw a pile of hair from my eye brows. I didn’t even realize I was doing it.

-It was this really strong urge I couldn’t ignore.

-I had to make it look right.

-It didn’t feel right. I had to keep picking at it until it was smooth.

-I know I’m not supposed to do it but it helps me calm down.

-I’m ashamed of what I look like.


hair pulling and skin picking


1. What are Body-Focused Repetitive Behaviors (BFRBs)?

Hair-pulling disorder (officially called Trichotillomania), nail-biting disorder, and skin picking disorder (officially called Excoriation Disorder) fall into a category called Body Focused Repetitive Behaviors (BFRB’s).

These disorders are complicated because people engage in behaviors they don’t want to do over and over again. Their behaviors lead to negative physical and psychological results. They also take up a lot of time and negatively impact school, work, and relationships.

Someone struggling with a BFRB is usually really distressed. They don’t want to do this. They may also feel alone, out of control, and ashamed. As a result, they may keep their BFRB a secret. They usually try to find ways to deal with the behavior like covering up different body parts, using makeup or wigs, and avoiding social situations.


skin picking and hair pulling


2. Why do they do this?

A BFRB is not a nervous tic or habit.

People who engage in skin-picking or hair-pulling usually do it in response to something stressful or needing to make an area look right.

Many people do it while zoning out and don’t realize they are doing it.

skin picking and hair pulling


3. What causes BFRB’s?

We don’t know the exact cause of BFRB’s.

However, research shows that it can be caused by a combination of environmental and familial stressors, coping responses, genetics, temperament, and age when symptoms started.


hair pulling and skin picking


4. How is it treated?

Learning about BFRBs and its treatment is an important first step. Research shows that Cognitive Behavioral Therapy (CBT) leads to good short and long term results.

It’s essential to see someone who specializes in BFRBs.

Treating hair pulling or skin picking like an anxiety disorder or OCD can actually make it worse.

Treatment involves working towards changing and managing the behavior and learning alternative ways to respond to unhelpful thoughts and feelings.

People also learn how to have self compassion, acceptance, and that set backs are part of the process.


skin picking and hair pulling


5. If I have one of these disorders, what should I do?

  • Remember that you are not alone.
  • Seek out a Cognitive Behavioral therapist who specializes in skin picking or hair pulling. Remember that treatment will be hard and take a while, but the investment is worth it.
  • Give yourself a break. You’re using this as a coping strategy. When you learn new strategies, your behavior will change.
  • Understand that setbacks are part of the process. A setback doesn’t make you a failure or a bad person. What matters more is how you bounce back.


You are not alone. You are not your disorder. There is help available.

Our practice has a subspeciality in treating BFRBs. When you’re ready, please call so we help you. 


Whatever your struggles, you can do this.

All the best,

Twisa Desai, M.A. LPC

Psychotherapist practicing at Bucks County Anxiety Center