What Are Body-Focused Repetitive Behaviours (Skin Picking and Hair Pulling)

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Body-focused repetitive behaviours, often shortened to BFRBs, are repeated behaviours directed at the body that cause physical damage or distress and are difficult to stop. The most common are skin picking, known clinically as excoriation disorder, and hair pulling, known as trichotillomania. Others include nail biting, cheek or lip biting, and nail picking. These behaviours are grouped with obsessive-compulsive and related conditions, but they differ from OCD because they are usually not driven by intrusive thoughts. BFRBs are common and often hidden because of shame. They are not a sign of weak willpower, and effective help is available.

What BFRBs Look Like

• Picking at skin, scabs, or perceived imperfections, sometimes for long periods.
• Pulling hair from the scalp, eyebrows, eyelashes, or elsewhere.
• Biting nails or the skin around them until they bleed.
• Repeated attempts to stop or cut back that do not last.
• Visible effects, such as wounds, scarring, or bald patches.
• Covering skin or hair loss with clothing, makeup, hats, or hairstyles.
• Avoiding activities such as swimming, intimacy, or haircuts.
• Feeling shame, embarrassment, or frustration afterward.

BFRBs can be focused, done deliberately in response to an urge or a feeling that something is not right, or automatic, happening without awareness while reading, watching a screen, or driving. Many people experience both.

Why It Happens

BFRBs appear to involve a combination of genetics, brain differences in habit and reward systems, and learned patterns. They often begin in late childhood or adolescence. The behaviours can serve several functions. They may reduce tension, anxiety, or boredom, bring sensory satisfaction, or provide a sense of relief or evenness. Because the behaviour brings short-term relief, it becomes reinforced and harder to stop.

Stress, fatigue, being on edge, and sedentary activities often increase BFRBs. They are common among people with anxiety, ADHD, and depression. Skin picking can also overlap with body dysmorphic disorder when picking is driven by concern about appearance. Understanding the triggers and functions for each person is key to change.

Shame often keeps BFRBs hidden for years. Many people have never told anyone, including their doctor, and believe they are the only one. Learning that these behaviours are common and recognized conditions can bring relief and make it easier to reach out for help.

What They Are Not

• Not self-harm. BFRBs are usually not intended to cause injury, though damage can occur.
• Not just a bad habit. They can be persistent conditions that need targeted treatment.
• Not the same as OCD, though they are related. BFRBs are usually not driven by obsessions.
• Not solved by willpower alone. Structured strategies are much more effective.

How They Are Assessed and Treated

A clinician will ask about which behaviours occur, when and where, what triggers them, how they feel before and after, and the impact on health and life. A doctor may treat skin or scalp damage. Habit reversal training is the most studied treatment. It involves increasing awareness of the behaviour and its warning signs, and learning a competing response, such as clenching fists or holding an object, when the urge arises. The comprehensive behavioural model expands this by addressing sensory, emotional, cognitive, motor, and environmental factors. Practical strategies include wearing gloves or bandages, keeping hands busy with fidget items, and changing environments where the behaviour happens. Acceptance-based approaches help people tolerate urges without acting. Support groups can reduce shame and isolation.

Getting Support at Pacific Maple Psych Centre

If picking, pulling, or biting feels out of your control, therapy can help you understand your patterns and build practical strategies to reduce them, without shame.