The silent suffering of hair-pulling and skin-picking

August 18, 2017 by Leanne Christian, LPC

Imagine for a moment the most intense itch you have ever had. The burning sensation of discomfort screaming at you to just scratch for sweet relief. For whatever reason, you are unable to scratch this itch. Maybe you can’t reach it or maybe it is in a less-than-conspicuous spot. But you are forced to sit with that powerful fiery itch. Nobody can know that you have this itch. If you touch it, you won’t be able to stop yourself. Soon, you’ll spend countless time and energy on taking care of all the itching that ensues. It seems like there is no other way to take care of this itch than to just suffer in silence. This is the closest comparison to what it feels like to have a body-focused repetitive behavior such as hair-pulling (Trichotillomania) or skin-picking (Excoriation).
Body focused repetitive behavior (BFRB) is a term that describes any type of compulsive grooming behavior that results in damage to the body. Trichotillomania is a disorder characterized by the behavior of pulling one’s hair from the scalp, eyelashes, eyebrows, or any other parts of the body. People with excoriation repetitively touch, rub, scratch, or dig at their skin often in attempt to improve it. Despite efforts and devastating consequences, these individuals cannot stop their behaviors. Avoiding common activities such as haircuts or beach days is commonplace for those with body-focused repetitive behaviors. It is rare as a clinician that somebody enters my office and asks for help with the seemingly uncommon problem of pulling their hair or picking their skin. Often, individuals who suffer from these disorders do not seek treatment out of shame or embarrassment.
What is surprising is how common these disorders are. The best research suggests that over 3% of the population live with a BRFB. They typically come about around puberty and affect both males and females, although it is estimated that females outnumber males 9 to 1. There are several theories about what causes hair pulling or skin picking. What has been established is that there is an inherited predisposition that in combination with other factors—such as environment or temperament—lead to people engaging in these behaviors. While some may think that this is a form of self-harm or self-mutilation, the reality is that the behaviors are more to relieve stress or receive gratification (much like your insatiable itch).
There is a lot left to be understood about these disorders, the TLC Foundation for Body Focused Repetitive Behaviors ( offers the most up to date information and research from experts working in the field. Treatment entails a combination of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, Habit Reversal Training, or most recently the Comprehensive Behavioral Therapy Model.
If you are suffering from a Body Focused Repetitive Behavior, you do not need to suffer in silence. Change is possible! Please feel free to reach out to schedule an appointment with one of our clinicians.


Leanne Christian is a Licensed Professional Counselor with continuing education training in the treatment of Body Focused Repetitive Behaviors.

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