Skin Picking and Hair Pulling
Skin picking, hair pulling and other body-focused repetitive behaviors (BFRBs) like nail biting, nose picking and lip/cheek chewing can be isolating and embarrassing experiences. It is likely that you have tried many times to stop engaging in picking, pulling or biting, and even had success for days or weeks at a time before the cycle started up again. The trick is that BFRBs can be both positively reinforcing because they feel good or help us (e.g., increasing focus), and negatively reinforcing because they remove unpleasant experiences (e.g., anxiety, tingling sensations, looping thoughts about needing to have smooth skin). This heightened reinforcement makes the behavior even harder to limit, much less stop. It also explains why single techniques for change (e.g., getting a fidget, wearing gloves, a loved one pointing it out) does not work. I can help you develop a new, more thorough, plan to help break this pattern and build your confidence in being able to “surf” the urges to pick, pull and bite.
The Comprehensive Model for Behavioral Treatment (ComB) is effective in addressing BFRBs. Our work will involve identifying the triggers for your BFRB, including situations in which you are most likely to pick, pull or bite, sensory cues (e.g., running your fingers over your skin or hair) and intrusive thoughts that may show up (e.g., evening out that one nail is all that you need to do). We then develop and try out alternative responses to those triggers (e.g., changes to your environment, behaviors that compete with your BFRB like keeping your hands busy or wounds covered) and track the effectiveness of these strategies. We will continue to work together to refine this plan, with the goal for you to be able to continue with modifying the plan on your own after we practice it together for a few sessions. I want you to feel confident in better understanding your BFRB and shifting your relationship to it (e.g., it is a “tell” that you need more rest, connection or patience), as well as how to best respond to future urges and triggers.
I find that my clients also appreciate the use of Acceptance and Commitment Therapy (ACT) for BFRBs, as it helps us to focus on what you want in your life that is more important than your BFRB (e.g., going swimming, spending time with others, feeling more confident). We will talk about what you would want your life to look like and build towards it, which helps to supercharge the plan that we will create together to address your BFRB urges. Together, we can develop a sustainable plan to help you live the life you want, your BFRB and new responses to it included.
For podcast interviews I did about treating BFRBs, check out episode 32 of Fidget, episode 52 of The OCD Family Podcast (and the great YouTube animation Nicole Morris did of that episode here), and episode 21 of the Everything You Want to Know About Therapy *but were too afraid to ask. For an interview I gave about BFRBs and their impact on intimacy, please see this article on Giddy.