Most people could say they have picked at their skin or pulled at their hair from time to time. If you engage in either or both of these activities excessively, with repeated but unsuccessful attempts to stop which can cause significant impairment or disruption to your functioning, you may or may not realise that there is a name for this. Body-Focused Repetitive Behaviours, or BFRBs, describe a cluster of behaviours including habitual hair pulling, skin picking, nail biting, nose picking, and lip or cheek biting.
At this stage, hair pulling and skin picking are the only BFRBs recognised in the psychological “bible” of mental disorders.
But for today, we’re going to focus on moments where life gets Trichy.
Trichotillomania (TTM) is more common than you might think with up to 6% of the general population experiencing distressing hair pulling. It’s more common in females but many males also experience this.
People with TTM can pull hair from any part of their body including their scalp, eye brows, eye lashes, beards, pubic regions, legs and arms…
A question I often get asked by my clients is why? Why do I pull my hair? Why can’t I stop? There are a few proposed explanations for this. Some researchers believe there may be a biological predisposition or ‘genetic plan’ for these behaviours. Others believe that these behaviours are “nervous habits” that are performed in response to tension and threat.
I actually researched this idea a little bit to try to understand the function of hair pulling. I found that people who pull their hair have greater difficulties with emotion regulation, distress tolerance and experiential avoidance relative to people who don’t. This is consistent with other research that has found similar results for TTM and other BFRBs (Arabatzoudis, Rehm, Nedeljkovic & Moulding, 2017).
While the emotional element is a big part of many people’s TTM “profile”, it’s not quite so simple. Mansueto and colleagues have suggested that all BFRBs are influenced by not only affective elements but sensory, cognitive, motor (the thing most people refer to as a “habit”) and place (external/situational) domains.
Unfortunately, many BFRBs are associated high levels of shame, isolation and low self-esteem (Arabatzoudis, Rehm, Nedeljkovic & Moulding, 2017). It’s for this reason that many people with TTM rarely discuss their condition with others and in turn, avoid seeking face-to-face treatment (Arabatzoudis, Rehm & Nedeljkovic, 2021).
This is part of the reason that Hannah and I developed ‘Shoo the Shame’ – a group therapy program for BFRBs. As the great Brene Brown says: “If we can share our story with someone who responds with empathy & understanding, shame can’t survive”. If you’d rather share your story with one of our great clinicians, individual appointments are also available. Let’s shoo the shame together!
References
Arabatzoudis, T., Rehm, I., & Nedeljkovic, M. (2021). A needs analysis for the development of an internet-delivered cognitive-behavioural treatment (iCBT) program for trichotillomania. Journal of Obsessive-Compulsive and Related Disorders, 31, 1-10.
Arabatzoudis, T., Rehm, I., Nedeljkovic, M., & Moulding, R. (2017). Emotion regulation in individuals with and without trichotillomania. Journal of Obsessive-Compulsive and Related Disorders. 12. 87-94.
Mansueto, CS., Mansfield Vavrichek, S., & Goldfinger Golomb, R. (2020). Overcoming body focussed repetitive behaviours: A comprehensive behavioural treatment for hair pulling and skin picking. New Harbinger Publications. Oakland: CA.