Hair Pulling & Skin Picking: Understanding Body-Focused Repetitive Behaviors
/Why Is It So Hard to Stop Hair Pulling or Skin Picking?
Body-focused repetitive behaviors (BFRBs) are repetitive behaviors that involve the hair, skin, or nails and can be difficult to stop—even when you want to. Common BFRBs include hair pulling (trichotillomania), skin picking (excoriation disorder), and repetitive nail biting. These behaviors can lead to physical discomfort, shame, frustration, and anxiety about how others perceive you.
At Downtown Psychological Services, we help individuals better understand their BFRBs and develop practical strategies for changing these patterns.
What Are Body-Focused Repetitive Behaviors?
BFRBs often happen automatically or in response to certain emotions, thoughts, or physical sensations. Someone might pull their hair while working, pick their skin while watching television, or bite their nails when feeling anxious. For some people, the behavior provides a temporary sense of relief or satisfaction, which can make the cycle difficult to break.
Importantly, BFRBs are not simply a matter of willpower. They can become deeply ingrained habits involving both emotional triggers and automatic behaviors.
Common Triggers for Hair Pulling and Skin Picking
BFRBs can occur in many different situations. Common triggers include:
Stress, anxiety, or emotional discomfort
Boredom or understimulation
Difficulty concentrating
Feeling or noticing an imperfection in the skin or hair
Fatigue or being lost in thought
Certain environments or routines
Learning to identify your personal triggers is often the first step toward changing the behavior.
What Is Habit Reversal Training?
One commonly used behavioral approach for BFRBs is Habit Reversal Training (HRT). Rather than simply telling yourself to "stop," HRT focuses on increasing awareness of the behavior and developing alternative responses.
Treatment may include:
Awareness training: Learning to recognize when, where, and why the behavior occurs—including subtle urges or movements that happen before the behavior.
Competing responses: Practicing a safer behavior that makes the BFRB more difficult to perform when an urge arises.
Trigger management: Identifying situations, emotions, or environmental cues that increase the likelihood of hair pulling or skin picking.
Building new habits: Repeating alternative responses so that healthier behaviors gradually become easier and more automatic.
You Don't Have to Eliminate Every Urge
An important part of BFRB treatment is learning that an urge does not have to result in an action. The goal isn't necessarily to never experience an urge to pull or pick. Instead, therapy can help you develop the ability to notice the urge, tolerate the discomfort, and choose how you respond.
Progress can take time, and setbacks do not mean that treatment isn't working.
Therapy for BFRBs in NYC
If hair pulling, skin picking, or another repetitive behavior is interfering with your daily life, relationships, confidence, or physical well-being, therapy can help. At Downtown Psychological Services, our therapists use behavioral and evidence-based approaches to help clients understand the patterns underlying BFRBs and develop practical tools for change.
You don't have to rely on willpower alone. With greater awareness, behavioral strategies, and the right support, it is possible to develop a different relationship with your urges and behaviors. Contact us to schedule a free 10-15 minute consultation to learn more about how we can help.
