Stopping nail-biting, hair pulling, skin picking
Repetitive self-grooming behavior resulting in damage to the body is known as BFRB (body-focused repetitive behavior). The difference between normal grooming behaviors and the BFRB is when the behavior causes substantial personal distress or interferes with daily functioning. The two most common are hair pulling (trichotillomania) and skin picking (excoriation).
BFRB body-focused repetitive behavior
Although studies show that the BFRBs are quite widespread (about 2 to 5% of the general public suffers from trichotillomania, and 5% from excoriation), there are actually few professionals who have up-to-date information on how to best treat these conditions.
These behaviors typically begin between the ages of 11 and 15, although they can start at any age. We don’t fully know yet why some people engage in these behavior and others don’t, although research is shown that some people may have an inherited predisposition.
An inherited predisposition
It is important to note however that even with an inherited predisposition, many other factors are involved: temperament, environment, age of onset and family stress factors. Some people assume that these behaviors are a sign of some unresolved problem that needs to be addressed for the BFRB to get better, but the evidence suggests that they are not generally an indication of an unresolved trauma.
Rather, those who engage in these behaviors would seem to do so to relieve stress or to experience gratification or other sensations; it is not the same thing as self-mutilation.
CBT psychotherapy has been shown by existing studies to be the treatment of choice; it is superior to medication and treatment outcome. Other important factors in treatment include social support from loved ones, awareness training to help the person focus on the circumstances during which the behaviors occur, and competing response training to substitute another response to the urges usually met with BFRB.
The comprehensive behavioral (ComB) treatment model
The comprehensive behavioral (ComB) treatment model assumes that the behaviors meet one or more need in the individual, such as helping them to feel like a goal is been accomplished, to fall asleep or simply to relax. Working with the therapist in this approach, the client learns to understand their internal and external triggers and how to choose individualized strategies.
For example a client who bites their nails to stop worrying can be taught how to think differently and reduce their worry; another client who pulls their hair can be encouraged to use a calm to not only calm the itching that triggers the behavior, but also to discourage them from having their fingertips in contact with their scalp. Each strategy is designed to meet the unique needs their achieved by the BFRB.
Many sufferers experience shame, isolation and low self-esteem as a result of trying to cope with their behaviors for years. Some of my clients have found it difficult to establish close relationships or have avoided certain professional goals as well. Stopping a BFRB can be life-changing; but it is important as well to remain vigilant, because the behaviors can return after even a very long period of abstinence. Consulting with a professional familiar with these behaviors is crucial to bringing it to an end.