Trichotillomania (hair pulling disorder) and skin picking disorder (dermatillomania) are body-focused repetitive behaviours, or BFRBs. They are not self-harm: the aim is not pain or injury, the damage is unintended, and much of it happens automatically.
Key points
- Trichotillomania and skin picking disorder are body-focused repetitive behaviours, or BFRBs.
- They are not self-harm: the aim is not pain or injury, the damage is unintended, and much of it happens automatically.
- Both run on rising tension and relief rather than the intrusive thoughts that drive OCD, though ICD-11 groups them with obsessive-compulsive and related disorders.
- Habit reversal training, a form of CBT, has the most evidence behind it.
- No NICE guideline covers either condition, and neither is on the NHS Talking Therapies self-referral list.
Symptoms
- Hair pulled from the scalp, eyebrows, eyelashes or elsewhere on the body; patchy hair loss in unusual shapes.
- Picking at spots, moles, scabs or uneven skin, often to make it smooth; bruising, cuts, bleeding, scarring and a risk of infection.
- An urge that builds until the behaviour happens, followed by relief; repeated attempts to cut down that have not worked.
Causes and risk factors
- Dealing with stress or anxiety; changes in brain chemistry; changes in hormone levels during puberty; a family history.
- A behaviour that began as a habit and became hard to break; not caused by attention-seeking or weak willpower.
Treatment
- Habit reversal training: keeping a diary of when it happens, working out triggers, replacing the behaviour with a different action.
- CBT more broadly, looking at the thoughts and feelings around the behaviour and changing the setting so it is harder to start.
- Antidepressants are not usually prescribed for trichotillomania; an SSRI is sometimes used for skin picking disorder alongside therapy.
When to speak to a professional
- You are pulling out hair or picking your skin regularly and cannot stop, or it is causing hair loss, sores, scarring or signs of infection.
- It is taking up hours of your day, or you are avoiding people because of it.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.