I’m sure a lot of you can relate to biting your nails, picking at your skin or pulling out some hairs from time to time. Maybe it is an occasional habit that happens mindlessly. You might find it annoying and prefer not to do it, but it doesn’t really impact much on your life or functioning.
There might be some of you, though, that repetitively engage in pulling or picking to the extent that it causes hair loss or other damage to your skin or scalp. Maybe these episodes of pulling or picking take up quite a bit of time in your day, ranging from a few minutes up to a few hours. These episodes may feel out of control and you have difficulty stopping. The repetitive nature of the behaviour perhaps disrupts your day to day functioning - maybe you avoid certain situations because you feel embarrassed about the physical damage the picking or pulling has created, or you avoid certain situations that may trigger the desire to pick or pull. You may experience a range of uncomfortable emotions in relation to your picking or pulling, like shame, embarrassment, isolation, and low self-esteem.
If you are resonating with that second paragraph, you may or may not realise that there is a name for what you are experiencing. Body-Focused Repetitive Behaviours (BFRBs) describe a cluster of behaviours most commonly including hair pulling (Trichotillomania), skin picking (Excoriation Disorder), nail, lip & cheek biting.
Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines both hair pulling, called Trichotillomania, and skin picking, called Excoriation Disorder, as habitual behaviours of clinical concern, but that’s not to say that other BFRBs like different forms of biting are less important or distressing. Whether it is habitual hair pulling, skin picking, or a different BFRB, what is common to these behaviours is repeated unsuccessful attempts to reduce or stop the behaviour, and significant impairment in day to day functioning.
Researchers are increasingly investigating the factors that contribute to the development and maintenance of BFRBs in order to increase our knowledge in effective treatment. Currently, there is no single satisfying answer to the fundamental question: why do BFRBs develop? What we do have are a number of proposed theories that attempt to explain how BFRBs start and are maintained. There is also not one single treatment approach that seems to be the ‘gold standard’, but rather a combination of therapies that have shown to be effective in reducing BFRBs.
If you are somebody struggling with a BFRB, know that you are absolutely not alone and it is not your fault. If you would like to learn more about the things discussed in this article and would like to learn strategies for reducing your BFRB, I have some good news! Here at Melbourne Wellbeing Group we are introducing a group therapy program for adults living with BFRBs. It will be a 6 week program, each session is 2 hours long and will include opportunities for learning, skill development and practice, and connection with others who are experiencing BFRBs.
If you would like to hear more about this group, or would prefer to speak one on one with one of our psychologists about your BFRB, please don’t hesitate to give our team a call on (03) 9882 8874 or email admin@melbournewellbeinggroup.com.au
This blog was written and prepared by Hannah Gersh – Psychologist at Melbourne Wellbeing Group.