Hair-pulling (trichotillomania) and skin-picking (excoriation disorder, sometimes called dermatillomania) are the two most common body-focused repetitive behaviors (BFRBs) — a family of habits that also includes nail-biting and cheek- or lip-biting. BFRBs typically start as a way of managing tension, boredom, or intense concentration, and often happen partly on autopilot: many people notice they've been pulling or picking only after the fact, mid-task, or while reading, driving, or watching TV. Over time the behavior can cause real physical damage (bald patches, sores, scarring) and a painful cycle of shame and secrecy that makes it harder to talk about or ask for help. It's important to know this is not a matter of willpower, vanity, or self-harm intent — BFRBs are recognized, OCD-spectrum conditions with a well-studied and effective treatment approach called habit reversal training.
A Few Things You Can Try Today
- Track your triggers for a few days before trying to stop. Notice the time of day, location, activity, and emotional state (bored, anxious, focused, tired) right before an episode. Awareness of your specific pattern is the foundation of habit reversal training and makes every other strategy more effective.
- Build a "competing response." The moment you notice the urge (or catch your hand already moving), replace the action with something incompatible for 1-2 minutes — clench your fists, sit on your hands, squeeze a stress ball, or hold a mug of tea. The urge itself typically peaks and fades within a couple of minutes if you don't act on it.
- Make the behavior physically harder to do. Small barriers help more than they seem like they should: bandages or tape on fingertips, gloves for high-risk times (like reading in bed), keeping a textured fidget object within reach, or sitting somewhere without a mirror nearby.
Our Grounding & Breathing tool can help in the moments when tension or the urge to pull or pick feels strongest, and our Thought Record tool can help you work through the shame or self-criticism that often follows an episode.
Where to Go for More
- The TLC Foundation for BFRBs - The leading nonprofit dedicated to body-focused repetitive behaviors, with free guides, a professional directory, and peer support groups.
- Wikipedia - Trichotillomania - An accessible overview of hair-pulling disorder, its causes, and treatment approaches including habit reversal training.
- Anxiety & Depression Association of America - Excoriation (Skin-Picking) Disorder - Explains the diagnostic picture, related conditions, and how to find effective treatment.
These are general starting points, not a diagnosis or a complete treatment plan.