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Body Focused Repetitive Behaviors

Most people have heard of Obsessive Compulsive Disorder (OCD), but many are unaware of what are called “OCD Spectrum Disorders”. One category of “OCD Spectrum Disorders” is called Body Focused Repetitive Behaviors or BFRB’s. The BFRB’s that we see most often at our anxiety clinic are Trichotillomania and Dermatillomania, which most people have never heard of. These two disorders are, respectively, pulling out ones hair and picking ones skin. BFRB’s can also include other behaviors such as nail biting or biting the skin inside of one's mouth, though Trichotillomania and Dermatillomania are by far the most common BFRB’s that we see. The hair pulling can be from any part of the body, but is most often from the head, eyelashes or eyebrows and occasionally from the legs or pubic area. Skin picking can, likewise, be at any location on the body but face, scalp, legs and arms are most common. These are called “OCD Spectrum Disorders” because they co-occur frequently with OCD.The hair pulling/skin picking can range from occasionally pulling out a stray hair or two to pulling out entire eyebrows, eyelashes or large patches of hair on one’s head. Skin picking can have similar variations ranging from removing a few “bumps” on the skin to creating large sores/scabs from all the picking.  Our clients are universally extremely frustrated by their inability to stop these behaviors that appear so self-destructive. BFRB’s can either be focused (you are aware of what you’re doing) or unfocused (you don’t realize you’re pulling until you happen to look down and see the pile of hair on the floor next to you). Treatment often begins by keeping a diary of pulling/picking episodes over the course of several weeks to become more and more aware of when and--with some luck--why you pull/pick. The diary also has the effect of making you more aware – so that what was “unfocused” behavior becomes more and more “focused”. This is a necessary step because if you are unaware of what you’re doing it is virtually impossible to stop.  Becoming aware is, unfortunately, often only the first step. Some people will find that the diary helps them stop their pulling/picking, but most people will find it is a necessary but not sufficient condition for change. Besides raising awareness, the diary helps us pinpoint where, when, how and even sometimes why we pull/pick. If we know where and when we pull/pick then when we go “there” at that “time” we can be especially careful to not start the BFRB in the first place. Of course this is much easier said than done, but it is a start. Knowing “how” we pull/pick can also be very useful. If we know, for example, we usually use the thumb and first finger on our right hand to pull out the hair, then we can cover those fingers (band aids or gloves) and thus reduce the probability we will pull/pick. In fact, using “barriers” is one of the more effective and easily implemented treatment methods. The “why” we pull/pick may be an attempt to regulate our emotions. If we are upset it may be an attempt to calm ourselves down and vice versa, if we are bored it may be an attempt to rev ourselves up a bit. Few people have ever heard of BFRB’s and know that these disorder even exist, and fewer still realize that there are treatment methods for these disorders. An excellent source of information and resources for BFRB’s is the Trichotillomania Learning Center (www.trich.org) in Santa Cruz, California. It is full of very useful information. There is even a therapist locator service to help you find a therapist in your area who is qualified to treat BFRB’s.