Body focused repetitive behaviors and the silent suffering
A few years ago, a young lady scheduled an appointment with me. She wanted help to stop pulling out her hair (#trichotillomania). We will call her Sarah. It took her decades to get help for the problem. Sarah reported feeling extreme shame and guilt about pulling. She had hidden it from her family and friends her whole life. She told me that she had tried to stop pulling on many occasions for many years but was never successful. She felt very hopeless and discouraged. She told me that she gathered all her courage when she contacted me for help.
What are the common themes associated with hair pulling, skin picking, and nail biting? Shame, distress, feeling out of control, secrecy, inadequacy, frustration, anxiety, boredom, wasting hours on end, bald spots, thinning hair, infections on the skin, bleeding, and so on. These behaviors fall in the category called “body-focused repetitive behaviors” (#BFRBs). You’ve probably made efforts to stop but haven’t been successful. You’ve probably felt frustrated and hopeless about not being able to stop. You’ve probably kept these behaviors a secret. BFRBs are some of the least understood and researched psychological issues.
But, there is hope. An empirically tested behavioral treatment program for picking, pulling, nail biting, and other BFRBs is available. It’s called the Comprehensive Model for Behavioral Treatment (ComB). With Sarah, we figured out the function of the pulling. She would engage in pulling when she was bored, anxious, excited, happy, etc. It became evident that whenever she felt over or under stimulated, she had the urge to pull. She also found the tactile sensation of finding the hair to pull and then pulling it to be rewarding. She started monitoring her pulling behaviors and some other information like her thoughts, feelings, location, intensity of the urge, amount of time and such. We worked on finding alternatives for Sarah for getting the tactile sensation and to regulate her feelings. With some trial and error, we modified things as needed. We also worked on mindfulness strategies like breathing exercises to help with regulating her feelings and to increase her awareness. For the first time in her life, Sarah started feeling hopeful about getting better because she was using tools that were helping. She learned to not rely on her will power but on strategies that can be replicated. Sarah understood that this is an issue she will need to work on for years to come with but now she has tools to manage it better. Sarah won the battle against the “trichster”, that’s what we called the hair pulling demon.