Body focused repetitive behaviors (BFRB’s) include
- hair-pulling (trichotillomania)
- skin-picking (dermatillomania/excoriation disorder)
- excessive nail-biting
- lip or mouth biting
- skin scratching
- nose-picking
If you struggle with these behaviors you know that they can be long-standing and very difficult to stop.
You may notice them occurring when you are anxious , bored, or under stress.
Life with these disorders can include a great deal of shame and isolation.
Many people begin avoiding activities, social situations or even intimacy.
BFRB’s are very common yet they remain greatly unaddressed in clinical settings.
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 how common these disorders are, very few therapists have specific training in this area. As a result most therapists fail to address all the issues necessary to create lasting change.
If you have been on your own with these difficult habits, you know how hard they can be to change. With the right support you can develop a whole new toolbox for addressing this difficulty and may be surprised to find that change is possible in ways you may never have thought possible 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 greatly reduce or eliminate hair-pulling, skin-picking and other BFRB’s. I offer a very broad and organized structure for change.
My approach begins with mindfulness. This 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 build motivation and inspiration for change using ACT (acceptance and commitment therapy) together with a somatic (body-centered) approach.
From there we will look more closely at the history of the behavior, its triggers, and the cognitive and emotional influences that sustain it. We will also explore the function the behavior serves.
We will consider the role of anxiety and I can offer somatic methods of reducing stress and physical activation that often drive BFRB’s.
Together we will develop strategies to change 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 helps build tolerance for urges and strengthens the 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.
For further resources related to body-focused repetitive behaviors, you may find this helpful:
The below TLC (Trichotillomania learning center) website, which was a valuable resource for many years and is sadly closing soon. the International OCD Foundation page above offers related information and support.
Mansueto, Charles (2011, April), Paper presented at TLC National Conference, SF, CA.