Hair-pulling (Trichotillomania), Skin-picking & other BFRB’s


Body focused repetitive behaviors (BFRB’s) include Hair-pulling (Trichotillomania), Skin-Picking (Dermatillomania or newly named Excoriation Disorder) and other compulsive behaviors such as excessive nail-biting, lip/mouth biting, skin scratching and even nose-picking etc. If you struggle with these behaviors you know that they can be long standing and incredibly hard to stop. You may find yourself engaging in these behaviors when you are anxious or when you are bored. Life with these disorders can be full of shame and isolation, often including avoidance of activities or even intimacy.

BFRB’s are very common and yet greatly unaddressed clinically. As many as 2-6.5% of the population struggles with BFRB’s. (Mansueto, 2011)

It is rare to find a therapist who knows about hair-pulling , skin-picking, and other body-focused repetitive behaviors. Despite the high prevalence of people who struggle with these disorders very few therapists have specific training in this area. As a result most therapists fail to address all the issues necessary to effect any lasting changes in the client’s behaviors. If you have been on your own with these difficult habits, you know how hard it is to change them. With the right support you will have a whole new toolbox for addressing this difficulty and you will be surprised to find that you can make changes that you have never known how to make before.

The most effective way to address hair-pulling and skin-picking is with a comprehensive approach. Because the triggers and functions of these behaviors are multidimensional, a similarly complex, multilevel treatment plan is needed. We will want to look at the ways your behavior is related to your thoughts, feelings, and nervous system.

I have extensive training, experience and success in helping people to greatly reduce or eliminate hair-pulling, skin-picking and other BFRB’s. I offer a very broad based and organized structure for change. My approach begins with mindfulness, which is a way of slowing down experience and increasing awareness, so that different choices become possible. The starting place is acceptance and decreasing judgment and shame. Next we will support and build motivation and inspiration for making a change through the use of ACT (acceptance and commitment therapy) and Motivational Interviewing. From there we can begin a more extensive survey of the history of the behavior, triggers, cognitive and emotional influences and a look at what it serves. We will consider the interface with anxiety and I can offer somatic (body-centered) methods of reducing stress and physical activation that can often drive the BFRB. Together we will come up with strategies and ways to change the triggers and responses so that a different outcome begins to occur. Finally I will support you in a process of exposure and response prevention (ERP) combined with mindfulness that will help you to build tolerance for the urges and increase your ability to resist acting on them.

As habits begin to change, so do neural pathways in the brain. As different neural pathways and networks are created, the urges will go down. No matter how long you have been dealing with these behaviors and their many negative impacts on your life, change is possible. I look forward to supporting you in this endeavor.

Group For Hair-Pullers and Skin-Pickers (Adults only)

Note: This group is offered 3 times per year and the next cycle will be SOON (hoping to start October 2017). Contact me soon, if you are interested in this next group.

Group for people who struggle with hair-pulling (Trichotillomania), skin-picking and other body-focused repetitive behaviors (BFRB’S) including lip and cheek biting, and excessive nail biting. The group will be educational, therapeutic and supportive. The focus will heavily oriented towards learning skills and practices to build tolerance of the urges and find other alternatives to engaging in the behaviors.

Goals of the group will be shame reduction, stress management, strategies for reducing/stopping, and alternate ways to regulate the nervous system.

The group will be mindfulness based, experiential, behavioral (CBT, ACT and ERP) and a place to find connection with others who are struggling with these disorders.

*12 week group
*Eves 7:30-9:30pm at office near downtown
*$60 per group session with sliding scale available for true financial hardship, $55 if paid in 2 installments

Call me to see if this group might be a fit for your recovery needs. It has been a very successful medium for growth, mutual support and reduction or cessation of these behaviors. The support is potentiated by the group structure which can offer shared accountability, inspiration and collaboration between group sessions.

Call me at 831-824-4540

For further resources in dealing with these issues visit:

Note: Any information or resources for Trichotillomania (Hair-pulling) is generally relative to Dermatillomania or Excoriation Disorder (skin-picking) or any other BFRB’s.

Mansueto, Charles (2011, April), Paper presented at TLC National Conference, SF, CA.