Compulsive Hair-Pulling and Skin-Picking: Help for Your OCD Symptoms

Body-Focused Repetitive Behaviors (BFRBs) are any self-grooming behaviors done in a repetitious manner that harm or damage your body. These include pulling or picking hair, skin, or nails, as well as biting or scraping, and can specifically focus on picking or biting of the skin like scabs, acne, or other skin imperfections, cuticles, nails, lips, and cheeks. They are formally known as Trichotillomania, a hair-pulling disorder and Excoriation, a skin-picking disorder. BFRBs affect between 2-10% of the general public.

Many of these behaviors can be considered normal grooming behaviors. However, if they cause you significant personal distress and/or interfere with your daily functioning, then they are considered to be BFRBs.

Habitual picking and pulling can be one of the hardest things to stop. So ingrained in your patterns of relating to your world and environment, they almost seem immovable. Raising your awareness of the emotions and thoughts associated with these behaviors and developing some simple behavior management tools can bring breakthrough in these areas.

I enjoy using documentation and observation as a tool in my practice to help my clients become more aware of and in control of their habitual pulling and picking.

Preparing to Chart: Set your mind-frame at the beginning The key here is OBSERVATION. This tool is not meant to shame you for how frequently you employ your habit. It simply gets around the fact that it is difficult to recall helpful information about your pulling without closely observing it.

I remind my clients to be non-judgmental with themselves as they do this activity. We are just attempting to open your eyes to what’s going on. Because shame and embarrassment are so much a part of this issue, this can be difficult to get around. The more you focus on it, the more ashamed you may feel. That is not the heart here. However, working through these very normal feelings is a part of this process.

Observation Phase

Set yourself a limited amount of time to do this and plan to chart daily. I recommend one to three weeks to observe. Do not overtly try to stop the behaviors. Instead, during this phase, document the following:

Action Phase

This phase involves two parts: Goal-setting and Thought and Emotions Work.

Goal Setting

After you have observed and have a good idea of your habits, next comes the action phase. Set a goal for how much you would like to decrease your behavior. Be realistic and patient with yourself. An extreme and quick goal will be overwhelming and discouraging if you do not meet it. Realistic goals consider the time it takes to learn, allow for mistakes, and see small gains as important steps in the right direction.

Thoughts and Emotions Work

The action phase also includes addressing the thoughts and emotions involved in your habit. If you have predominantly negative thoughts or self-talk during times when you are pulling, it will be important to work to change these thought patterns. If your emotions tend toward anxiety, self-doubt, or boredom, you will want to employ some tools to counter the thoughts leading to those emotions.

Here is an example of documentation done for the habit of hair-pulling:

Date: 5/28
Time of Day: 10:45pm
Doing: Scheduling for the week
Feeling: stressed, tension
Thinking: “There’s too much here, I can’t figure this out.”
Sensation seeking: itching
How many: Once

Date: 6/5
Time of Day: 10pm
Doing: Watching an intense movie
Feeling: tense
Thinking: “What’s going to happen next?”
How many: Once.

Date: 6/8
Time of day: 2pm
Doing: Homework
Feeling: Stress and worry, uncertain
Thinking: “What if I’m doing this wrong?”
How many: Twice. Front and side of my head.

As you practice non-judgemental observation of your habitual behaviors, you will start to catch yourself not wanting to engage in them right there in the moment. Your hand might move to smooth rather than pull. Your mind will begin to influence you to stop. What once felt so second-nature will now involve a decision you feel empowered to make. By spending time in the observation phase not trying to stop the behavior but simply to notice it, you are training your mind to become aware of the behaviours, which gives you power to change them. It’s important to remember, you don’t HAVE to stop the behaviors in the observation. But what might naturally begin to happen is that you do.