SKIN PICKING AND HAIR PULLING

WHAT IT IS

PCH provides treatment for skin picking (excoriation disorder) and hair pulling (trichotillomania). Referred to as body-focused repetitive behavior disorders (BFRBs), skin picking and hair pulling can be difficult for people to stop on their own. These behaviors can be automatic (e.g., a person unknowingly begins to pick or pull while bored in traffic) or focused (e.g., a person notices an increasing urge to pick or pull and feels relief or pleasure after doing so). People with these disorders often experience distress (e.g., embarrassment or worry about the behaviors) and impairment (e.g., avoidance of social situations or activities). These disorders combined impact six to nine million people in the United States each year. 

Common symptoms include frequent pulling of hair often resulting in hair loss and frequent skin picking behaviors often resulting in scarring or lesions. Those struggling with these disorders often repeatedly attempt to stop these behaviors. The behaviors are often used both in times of inattention (boredom) and in distress. 

ASSOCIATED CONCERNS

Skin picking and hair pulling can occur in association with other body-focused repetitive behaviors, such as nail biting or lip chewing. Many people with these concerns may also experience mood disturbance or obsessive compulsive disorder.

EVIDENCE BASED TREATMENTS OFFERED

Working with Body-Focused Repetitive Behaviors (BFRBs) requires a tailored treatment approach that employs interventions known as Habit Reversal Training (HRT) and Stimulus Control Therapy. Treatment also includes elements of Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) to augment the protocol and provide skills for managing distress or boredom without reverting back to the BFRBs.