Finding Relief From Hair Pulling, Skin Picking, and Other Body-Focused Repetitive Behaviors
If you pull your hair or pick your skin, you may have been told (directly or indirectly) to just stop.
And as a result, you’ve probably asked yourself why you can’t control it.
In actuality, these behaviors qualify as Body-Focused Repetitive Behaviors. BFRBs are very common and often misunderstood. Many people struggle in silence for years, believing it’s simply a bad habit that they cannot change.
We want you to know that BFRBs are very real, they’re not your fault, and they’re also treatable. Today, we’ll be covering what BFRBs are, why they feel so hard to ‘just stop,’ and the treatments we use for BFRBs here at Soultality Psychotherapy in Boston, MA.
What Are Body-Focused Repetitive Behaviors (BFRBs)?
Body-Focused Repetitive Behaviors are characterized by repetitive self-grooming focused on the body that can lead to unintentional damage. These behaviors often occur repeatedly despite attempts to stop and can cause physical injury, emotional distress, or disruption to daily life.
Common examples include:
Hair pulling (trichotillomania)
Skin picking (excoriation disorder)
Nail biting or cuticle picking
Lip or cheek biting
How BFRBs Relate to OCD (But Aren’t Exactly the Same)
BFRBs are part of the Obsessive Compulsive -Related Disorders spectrum, which can be confusing if you don't experience the classic symptoms of OCD, like unwanted thoughts and compulsions meant to neutralize anxiety.
Unlike OCD's intrusive thoughts and compulsions (which are usually performed to reduce anxiety about a feared outcome), BFRBs are often driven by urges, emotional states, sensory needs, and habits. Many people with BFRBs describe a buildup of tension followed by relief, satisfaction, or a sense of completion after the behavior.
While some people experience both OCD and BFRBs, it’s important to address the unique features of BFRBs using relevant treatment approaches that build awareness and strategies - and increase confidence in self-regulation and behavior change.
Understanding this connection can be deeply validating. It reframes the behavior from “Why am I doing this?” to “My brain is actually stuck in a loop that can be treated.”
Why BFRBs Feel So Hard to Stop
Full stop: If this were simply a bad habit, you likely would have stopped already.
BFRBs persist because they are satisfying. Picking or pulling may soothe anxiety, relieve tension, provide sensory satisfaction, reduce boredom, offer a focus, or create a feeling of control.
You may perceive your BFRB as a focused activity, or you may find the behavior happens when you are not paying full attention. Sometimes, it doesn’t even register until afterward. However, the brain learns that the behavior temporarily serves a purpose and keeps returning to it.
It’s not uncommon for people to harbor shame around their BFRBs, and they’ll go to great lengths to hide the effects of them. They may avoid haircuts, swimming, going to work, or spending time with their friends.
Most people with BFRBs have already tried very hard to stop on their own. They may have made promises to themselves, tried to avoid their triggers, worn barriers to prevent themselves from engaging, or tried to keep their hands occupied.
Without a personalized plan that addresses the unique aspects of a BFRB, urges and behaviors may persist and continue to consume time and energy. This creates ongoing cycles of shame, isolation, and discouragement, which can feel defeating and isolating, leading many people to believe change isn’t possible.
How Treatment for BFRBs Works
Treatment for Body-Focused Repetitive Behaviors is not about forcing immediate perfection or unrealistic goals. It’s about understanding why the behavior happens for each person and building practical, compassionate strategies that create real change over time.
When patients choose to work with a BFRB specialist at Soultality, their clinician will collaborate with them to understand their patterns, triggers, motivations, and goals. From there, they may use one or several evidence-based approaches tailored specifically to your needs.
These treatments may include:
Comprehensive Behavioral (ComB) Treatment
ComB is one of the most effective treatments for BFRBs because it looks at the whole picture. ComB identifies the triggers, such as sensory experiences, thoughts, emotions, movement patterns, and environments that reinforce picking or pulling. From there, the treatment will focus on developing strategies and alternative behaviors that gradually start replacing the behavior. This treatment plan also encourages self-care and stress reduction.
Habit Reversal Training (HRT)
HRT helps you become more aware of when the behavior is happening and teaches practical ways to interrupt the cycle. HRT involves functional analysis, awareness training, competing response training, and stimulus control. Habit Reversal centers on learning actions that are physically incompatible with picking or pulling.
Harm Reduction
Change does not have to be all-or-nothing. For many people, an important early step is reducing the behaviors that cause the most physical or emotional harm.
Harm reduction may focus on healing the skin or hair, preventing infections, decreasing the amount of time spent engaging in the behavior, and improving overall quality of life while longer-term strategies take effect.
ACT-Enhanced Behavioral Therapy
Acceptance and Commitment Therapy (ACT) helps people develop a new relationship with urges and uncomfortable emotions. Rather than fighting or suppressing urges (which often just intensifies the urges), you’ll learn skills for noticing urges, tolerating discomfort, and choosing alternative actions aligned with your values.
This approach can be especially powerful for reducing shame and self-criticism while increasing psychological flexibility.
What Recovery Can Look Like
Recovery looks different for every person, and it’s also important to know that ‘recovery’ from BFRBs doesn’t necessarily mean never experiencing an urge again.
Recovery for patients with BFRBs often looks like:
Feeling more in control of your actions
Spending less time engaged in the behavior
Healing physically and emotionally
Experiencing less secrecy and shame
Re-engaging in activities you’ve been avoiding
Having techniques that are useful when urges arise
But most importantly, it means life no longer revolves around managing the behavior. While the urges are not entirely eliminated 100% (and this is not the objective) clients will know how to handle their urges.
When is it Time to Seek Help for Your BFRB?
We commonly hear from patients that their BFRB isn’t that bad, or they’ve had it for years, so that’s just how they are, or that they should be able to just handle their BFRBs on their own.
But quite honestly, if it’s causing distress, damage, or taking up your mental space, that’s enough. You don’t have to wait for it to get terrible to seek support. Receiving help is an investment in your physical (and mental!) relief.
Some signs it may be time to reach out about your BFRBs are:
You’ve tried to stop on your own and keep getting stuck
You avoid certain lighting, mirrors, social situations, or intimacy
You feel shame or anxiety about someone noticing
The behavior increases during stress
You spend significant time thinking about or engaging in it
You notice scarring or injury
BFRB Treatment at Soultality Psychotherapy in Boston, MA
If hair-pulling, skin-picking, or related behaviors are affecting your life, professional support can make a meaningful difference. Our clinicians provide individualized, evidence-based treatment for Body-Focused Repetitive Behaviors in a compassionate, nonjudgmental setting.
You deserve care that addresses the full complexity of what you’re experiencing. We welcome you to fill out a new patient consultation and speak with us about BFRB treatment.