16 Mar Hair-Pulling, Skin-Picking, and Other Repetitive Behaviours: Can the cycle be broken?

Max is 14 years old. Max has been picking at the skin around his fingernails for two years, particularly when he is stressed, anxious and bored. His repetitive picking has caused bleeding and scarring, despite Max being routinely told to stop by parents and his family doctor and despite his many attempts to stop (e.g., putting Band-Aids on all fingers to prevent picking). Max feels alone, ashamed, frightened, and confused about his picking. After some googling, Max thinks he might have a Body-Focused Repetitive Behavior disorder.

What are Body-Focused Repetitive Behaviours (BFRBs)?
BFRBs is a term used to describe a number of ongoing repetitive behaviours (including hair-pulling, skin-picking, nail-biting, teeth-grinding) that result in physical damage (e.g., bleeding, noticeable hair loss, skin lesions) to the body despite considerable efforts by the sufferer to try and stop these behaviours.

  • BFRBS cause lots of distress (e.g., shame, isolation) and impairment (e.g., avoidance of social situations, missed school) despite efforts to try and stop these behaviours.
  • BFRBs are not simple habits that are easy to just stop if one tries hard enough (or else all youth I see with BFRBs would have definitely stopped!). Instead, BRFBs have underlying brain mechanisms and factors that cause urges (e.g., itching, tingling, pain) and actions of picking and pulling. Therefore, seeking a specialized therapist is needed to learn management and coping skills.

 

How many people have BFRBs?
BFRBs are thought to be more common than once believed, affecting at least 2-5% of the general population. Unfortunately, despite being widespread, few doctors are aware of how to effectively treat these disorders leaving many patients and parents confused and frightened about where to begin. Fortunately, at The Possibilities Clinic, we have treatment experts that offer comprehensive assessments as well as specialized and effective treatments for BFRBs.

Can BFRBs be treated?
Good news – treatments (namely behavioral therapy and medication) can help.
The most examined behavioural treatment in research for hair pulling, skin picking, tics, and other repetitive behaviours is called Habit Reversal Training (HRT). HRT involves helping a person become more aware of the circumstances/urges/cues/triggers (which include strong emotions: anger, frustration, uncomfortable thoughts about imperfection, and environmental factors: certain locations or activities that create temptations to engage in pulling, picking or tics) that lead to these behaviours. After awareness training, HRT involves teaching affected individuals to engage in an alternative behaviours/strategies that are incompatible to the BFRBs (e.g., whenever an individual feels the urge to pull her hair, she would make her hands into fists and lock her arms so she would be unable to pull in that moment).

HRT is often combined with other cognitive and behavioural coping techniques and strategies (e.g., teaching relaxation, mindfulness, and distress tolerance techniques to reduce/cope with stress) and acceptance and commitment techniques (e.g., understanding a person’s values and helping them accept urges/internal experiences without having to react or attempt to eliminate them) for optimal outcomes.

If you suspect that your child might have a BFRB, contact the clinic today to learn more about how we can help.

References:
1. Expert Consensus Treatment Guidelines – Trichotillomania Learning Society, 2016
2. Trichotillomania, Skin Picking, and Other Body-Focused Repetitive Behaviours, by Jon Grant, Dan Stein, Douglas Woods, and Nancy Keuthen, 2012

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