Body-Focused Repetitive Disorders might not be a familiar term to you, but you’ve probably heard of skin picking or hair pulling: the two most common examples. These behaviours come about as reactions to stress or anxiety triggers, and we’re certainly not short of potential triggers as we emerge from the pandemic.
The range of conditions known as BFRDs are compulsive and can often be spotted in childhood or teenage years, so if you know someone who is suffering in childhood or adulthood, here’s what to look out for.
Compulsive Skin Picking (CSP) or Skin Picking Disorder (SPD) is also known as excoriation, or dematillomania. Patients become fixated on existing blemishes or skin traits, such as acne, freckles, scars or moles, and pick at them. They may also identify flaws or blemishes that aren’t visible to others; therefore, we can find links to Body Dysmorphic Disorder (BDD).
Hair pulling is also known as trichotillomania, and can be shortened to trich. Patients pull hair from their bodies – mostly from the scalp, eyebrows, eyelashes, beard or moustache, but also from other parts of the body where hair grows. It can lead to bald patches, sores, and feelings of shame around the lost hair and the habit itself. Hair pulling can even become an addiction.
Reality TV star Sam Faiers has spoken out about trichotillomania, which she experiences as a compulsion to pull out her eyelashes – something that has been a part of her life for over 20 years. She has had psychological support for the condition, and talking therapy has helped her understand where it all began in childhood.
Other BFRBs include nail biting and cheek biting. They are all impulse control disorders, and can be linked to Obsessive Compulsive Disorder for the repetitive and sometimes ritualistic actions that take place. Sufferers feel comforted when they maintain these routines of skin picking and hair pulling, even though their action causes physical pain, tissue damage, scarring, and possibly infection.
These kinds of disorders usually emerge in teenage years, but children and adults can also be affected. One American study found that 38% of those with Compulsive Skin Picking also experienced Compulsive Hair Pulling.
Treatment for Body-Focused Repetitive Behaviour
Talking therapy is an important part of overall treatment for BFRBs. Talking with a qualified therapist gives a patient the chance to understand the root cause of their behaviour.
Cognitive Behavioural Therapy (CBT) is the most recommended talking therapy for skin picking, hair pulling and other BFRBs. This gives clients the chance to talk about their behaviours and understand the core beliefs and thoughts connected to them – the thinking patterns that cause them to act in a certain way. These thoughts may stretch back months or years, and could be connected to certain experiences or interactions in their past. You may also wish to consider Acceptance and Commitment Therapy (ACT).
Patients also need to find ways to stimulate their senses – particularly touch – without causing pain. Some may use similar actions to picking or pulling, but in a non-harmful setting, such as gardening (weeding, hoeing, aerating, etc., can all be therapeutic), grooming pets, flossing your teeth, or knitting.
Self-care routines can also help – getting a manicure or pedicure, practicing meditation, aromatherapy, using fidget spinners or stress squeezers to distract busy hands, and so on. Make sure you remove any tools that have helped you with your compulsion to pick or pull in the first place – for example, abrasive products, nail scissors, or tweezers.
For Liz Atkin, drawing has helped manage her repetitive skin picking. It’s a way of keeping her mind and body occupied; she uses charcoal to create dramatic sketches. She has also become known for making these sketches on the go, and giving them to strangers on the London Underground.
Compulsive skin pickers may wish to see a dermatologist to help repair their skin, but it is important to be honest about the condition to get effective help. Dermatologists need to know that the patient’s skin is affected by the skin picking, otherwise they may be looking for another cause unnecessarily.
The most important thing is to speak out and seek help for BFRDs, because they can’t be managed alone – proper intervention can make all the difference to a patient’s outlook and recovery.
Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk) and Lighthouse Psychology.