Do You Have An Uncontrollable Urge to Pull Or Pick?

Are you struggling with trichotillomania or another form of body-focused repetitive behavior (BFRB)? Have you tried hiding it from others due to shame or embarrassment? Unable to control it on your own, are you looking for a way to resist the urges and move beyond the compulsion to pull or pick?

If you suffer from trichotillomania—a body-focused repetitive disorder associated with recurrent and compulsive hair pulling you’re unable to stop despite repeated attempts to do so—it might be a behavior you’ve exhibited for as long as you can remember. Perhaps it’s something you do absentmindedly when you’re bored or at times when you feel anxious, depressed, or excited. Pulling your hair may create a pleasurable physical sensation or provide relief from overwhelming emotions. 

Even though you may vow to stop pulling out your hair, inevitably it happens again. Ashamed and embarrassed by your bald patches, you do whatever you can to hide them from others. This compulsion might adversely affect your life if you avoid situations where you may be discovered, such as swimming, doctor’s visits, hair salon appointments, or intimacy with your partner. The humiliation of trying to explain to someone why you do it is compounded by not understanding the reasons yourself.

You Might Pick At Your Skin Or Bite Your Nails

Perhaps another form of BFRB—such as skin picking, tongue chewing, hair cutting, or biting your nails, lips, or cheek—may be disrupting your life. Although you can typically conceal your repetitive behavior more easily than hair pulling, you wish you could control it. However, when the urge to pick or bite overtakes you, you can’t resist it.

Fortunately, treatment is available for trichotillomania and other BFRBs. With therapy, your hair pulling, or other repetitive and compulsive behavior disorder you struggle with can be subdued and controlled. 

BFRBs Can Be Embarrassing And Debilitating

BFRBs are among the most poorly understood, underdiagnosed, and untreated groups of disorders. Research suggests at least one out of 20 people has a BFRB, with trichotillomania alone believed to affect about 10 million people in the United States. Recently gathered evidence suggests that there are strong links between BFRBs and obsessive-compulsive disorder (OCD).¹ Hair pulling or skin picking can vary greatly in its severity and location on the body. For some of us, our BFRBs are mild and may only crop up from time to time. However, for others, when the urge arises, it may be so strong that it blocks out everything else. In more severe instances, we may cause ourselves physical injury. 

The Emotional Distress Associated With BFRBs Causes Other Issues

But for many of us, the shame and embarrassment we experience are worse than the physical damage we inflict on ourselves. BFRBs like trichotillomania can create painful isolation from our friends and family members, leading to tension and strained relationships. Feeling misunderstood and unable to stop the unwanted behavior, we often experience acute emotional distress. Sadly, suffering from a repetitive behavior disorder places us at higher risk for other mood or anxiety disorders. ² We often resist seeking help because we don’t know where to turn. Perhaps we’ve tried traditional therapy before without success. Or maybe we’re too embarrassed to admit to anyone that we have this problem. 

Even though it may feel like no one knows or understands what you are experiencing, you don’t have to go through this by yourself—help is available. Specific treatments for trichotillomania and other forms of BFRBs have been developed to help quiet the urges that compel you to engage in repetitive compulsive behaviors. 

Treatment For Trichotillomania And Other BFRBs Can Help You Resist The Urge To Pull Or Pick 

As a therapist who specializes in trichotillomania as well as other BFRBs, I’m accustomed to clients thinking they have to hide their condition from everyone they know. But you’re not alone. I have treated many people just like you and understand how your disorder impacts your life. 

I have been trained in Habit Reversal Training (HRT) and the Comprehensive Model for Behavioral Treatment (ComB). Each is a behavioral therapy specifically designed for the treatment of BFRBs and trichotillomania. Utilizing these therapies, I can help you learn skills to work against the urges to pick or pull. If you are struggling, there is hope and help available. 

What To Expect In Sessions

At the first intake session, I will ask you questions about your general background as well as the history of how your BFRB developed and evolved throughout your life. We will also spend some time discussing how it affects you now. Since you have had unique struggles and experiences, I will develop a customized treatment plan just for you. Thereafter, we will utilize the appropriate therapy to address your hair pulling or other BFRB. 

How HRT, And ComB Work for BFRB treatment

Through HRT, you will learn awareness training and skills to practice waiting out urges or replacing BFRBs with other, nonharmful behaviors. ComB is based on the belief that people pull or pick because it meets a need. The action may either soothe you or, conversely, stimulate you when you are bored. This therapy uses elements of HRT but it adds more depth to the treatment by looking at the whole picture. 

Rather than using a cookie-cutter approach, ComB first examines the unique factors that underlie why you pull or pick. We will assess the following:

• Cognitive – how do your thoughts affect picking or pulling?

• Mood – for example, does your BFRB occur when you’re anxious, bored, or frustrated?

• Physical – are there certain postures that make you more prone to pull or pick, such as when your hand is close to your face?

• Environment - where and when does the pulling or picking occur?

• Sensory cues – for example, is your trichotillomania triggered when it feels as though your scalp is itchy or tight and you’re attempting to relieve that sensation through pulling or picking?

After evaluating each factor, we will decide together which ones to address to help you with the picking or pulling. From there, I will help you to better understand the urges, recognize when they occur, and teach you skills that will help you resist acting on them.

Therapy offers hope that your trichotillomania will eventually become manageable.  Although BFRBs usually never go away completely, I will teach you skills to help redirect the strong urges. With a commitment to the process, the urges will diminish over time. 

But You May Wonder Whether Trichotillomania Treatment Is Right For You…

I’ve never been able to stop before so why will now be different? 

Fighting the urge to stop alone can be so challenging. Because the modalities of therapy I’m trained in were specifically developed for the treatment of trichotillomania and other BFRBs, I would encourage you to give them a chance. Working together, we will take a look at what is underlying your pulling or picking behavior. Once we have a better understanding of its origin, I will teach you the tools and skills to help you, remaining by your side all along the way. 

I’ve already tried therapy before and it didn’t help me with my trichotillomania.

If previous therapy was unsuccessful, I would encourage you to try again with someone who has specific knowledge, understanding, and training related to BFRBs. The modalities I specialize in—HRT, and the ComB model of therapy—have all been shown effective for the treatment of trichotillomania and other BFRBs³. Additionally, I am a member of the TLC Foundation, a leading institution for research and training in BFRBs. Not only have I trained with TLC in their professional institute, but I am also listed as a verified provider on their website. ⁴

It feels good to pick or pull so I don’t see how I can stop.  

It can often feel satisfying to pick or pull. In fact, studies have shown there is a dopamine response in the brain during a picking or pulling episode.⁵ And although it may feel good in the short term to succumb to the urge, in the long term you will often experience guilt, shame, and discouragement that you have no control to stop. In therapy, we will work together to break these negative patterns and work towards healthier coping mechanisms. 

Therapy Offers Hope You Can Finally Control Your BFRB

There is a life beyond the urges that make you feel out of control. If you would like to find out more about trichotillomania or BFRB treatment, please contact me so we can set up a free, 15-minute consultation today. 

1 https://www.anxiety.org/what-is-body-focused-repetitive-behavior-bfrb

2 https://www.psychologytoday.com/us/basics/body-focused-repetitive-behaviors#:~:text=Body-focused%20repetitive%20behaviors%2C%20or%20BFRBs%2C%20are%20a%20set,biting%2C%20or%20scraping%20one%27s%20hair%2C%20skin%2C%20or%20nails.

3 https://www.trichstop.com/Habit-Reversal-Training-for-Hair-Pulling

4 https://www.bfrb.org/find-help-support/find-a-therapist/record/0012I00%20002eELVgQAO

5 https://www.aocd.org/general/custom.asp?page=Trichotillomania#:~:text=The%20cause%20of%20trichotillomania%20is%20not%20clearly%20understood,may%20also%20contribute%20to%20this%20impulse%20control%20disorder.