BFRBs Behind the Behavior: Hair Pulling and Skin Picking Explained

Body-Focused Repetitive Behaviors, or BFRBs, are mental health conditions where a person repeatedly engages in behaviors that cause damage to their body. The two most well-known types are trichotillomania (hair pulling disorder) and excoriation disorder (skin picking disorder), although other forms exist such as nail biting and cheek biting.

These conditions affect both children and adults. They are often misunderstood and mistakenly seen as “bad habits,” when in fact they are recognized clinical disorders that can have a major impact on quality of life.

Trichotillomania (Hair Pulling Disorder)

Trichotillomania is characterized by the repeated urge to pull out hair from the scalp, eyebrows, eyelashes, or other parts of the body. Some people pull a few strands at a time, while others engage in longer sessions of pulling. The behavior is often accompanied by a sense of tension beforehand and relief afterward.

Over time, this can lead to noticeable hair loss, bald patches, irritation of the skin, and significant emotional distress. Many people with trichotillomania go to great lengths to hide the hair loss, which can affect self-esteem, relationships, and social interactions.

It is important to know that this is not simply about “choosing” to pull hair. The urges can feel overwhelming, and attempts to stop without support are often unsuccessful.

Excoriation Disorder (Skin Picking Disorder)

Excoriation disorder involves repeated picking at the skin, often targeting areas such as the face, arms, or scalp. This behavior can result in sores, scabs, scars, and sometimes infections. Similar to trichotillomania, skin picking is typically driven by urges or sensations, and it may bring temporary relief or satisfaction.

People with this condition often describe spending significant amounts of time picking, sometimes without realizing how long they have been doing it. The physical consequences can be painful, and the emotional burden is often heavy, with feelings of shame, embarrassment, or guilt.

Why Do BFRBs Happen?

The exact causes are not fully understood, but research suggests a combination of biological, psychological, and environmental factors. BFRBs are thought to be related to how the brain regulates habits, stress, and self-soothing behaviors. They are not caused by poor willpower or a lack of discipline.

Stress, boredom, or certain emotional states can trigger or worsen the behaviors, but urges may also appear without any clear trigger.

Treatment

The good news is that effective treatments exist. The most evidence-based therapy for BFRBs is Cognitive Behavioral Therapy (CBT), specifically a technique called Habit Reversal Training (HRT). This approach helps people recognize urges, build awareness of triggers, and replace harmful behaviors with healthier alternatives.

In some cases, medication may also play a role in reducing urges or treating related conditions such as anxiety or depression. Treatment is most effective when it is personalized, taking into account the individual’s unique needs and goals.

Moving Forward

If you or someone you love struggles with hair pulling, skin picking, or similar behaviors, it is important to know that you are not alone. BFRBs are common, and with professional support many people are able to manage urges, reduce symptoms, and regain confidence in daily life.