Body-Focused Repetitive Behaviors (BFRBs): Understanding Trichotillomania, Skin Picking, and Their Connection to OCD
If you’ve ever found yourself pulling your hair, picking at your skin, or engaging in other repetitive behaviors you feel you “can’t stop,” you’re not alone. These are known as Body-Focused Repetitive Behaviors (BFRBs), and the most common forms are trichotillomania (hair pulling) and excoriation disorder (skin picking).
Many people feel embarrassed, ashamed, or confused about why they can’t simply “just stop.” But the truth is: BFRBs are complex, they overlap with Obsessive-Compulsive Disorder (OCD), and most importantly, they’re treatable.
At Ember & Oak Counseling in Columbus, Ohio, I specialize in helping women navigate anxiety, OCD, and BFRBs with compassion and evidence-based care. My goal is to help you finally break free from the cycle of shame and regain confidence in yourself.
What Are Body-Focused Repetitive Behaviors?
BFRBs are self-grooming behaviors that involve pulling, picking, biting, or scratching in ways that cause damage. The most well-known include:
Trichotillomania: recurrent pulling of hair from the scalp, eyebrows, eyelashes, or other body areas.
Excoriation Disorder: repetitive skin picking that leads to sores, scabs, or scars.
While these behaviors may bring brief relief, they often spiral into guilt, frustration, or distress. Many women report avoiding mirrors, wearing hats, or using makeup to hide the impact. This can lead to feeling more isolated over time.
The Overlap Between BFRBs and OCD
BFRBs and OCD share common ground:
Urges vs. Obsessions: OCD involves intrusive thoughts that trigger compulsions. BFRBs, on the other hand, often start as an urge or tension that’s temporarily relieved by the behavior.
Cycle of Reinforcement: Both follow a pattern of discomfort, behavior, temporary relief, and then the return of discomfort.
Co-Occurrence: Research shows many individuals with BFRBs also experience OCD or anxiety, and the brain pathways involved in habit formation and self-regulation overlap.
This means that strategies effective for OCD can often be adapted to help with BFRBs.
Evidence-Based Treatments for Trichotillomania and Skin Picking
The good news is there are effective, evidence-based treatments for BFRBs. At Ember & Oak Counseling, I integrate these approaches into a personalized plan:
1. Cognitive Behavioral Therapy (CBT)
Helps identify triggers, thoughts, and patterns that keep the cycle going.
2. Habit Reversal Training (HRT)
A gold standard for BFRBs. HRT teaches awareness of the urge, then introduces competing responses (like clenching fists or using a fidget tool) to replace the behavior.
3. Comprehensive Behavioral (ComB) Model
Looks at sensory, emotional, cognitive, and environmental factors contributing to the behavior, and creates tailored strategies for each.
4. Acceptance and Commitment Therapy (ACT)
Encourages self-compassion, mindfulness, and alignment with values. Recovery is not only about stopping behaviors but also about building a life you want to live.
5. OCD-Informed Care
For those with both OCD and BFRBs, Exposure and Response Prevention (ERP) and other OCD-specific tools may be integrated into treatment.
Why Work With Ember & Oak Counseling
Healing from trichotillomania, skin picking, or OCD is not about willpower. It is about support, tools, and compassion.
At Ember & Oak Counseling, I work with women across Ohio (both in-person in Columbus and virtually) who feel trapped by anxiety, OCD, or BFRBs. My approach is:
Evidence-based: Using research-backed therapies like HRT, CBT, and ERP.
Compassionate: I understand the shame that comes with these struggles, and I create a judgment-free space.
Personalized: Every client’s triggers and patterns are unique, and your treatment should be too.
Next Steps: Begin Healing Today
You don’t have to stay stuck in the cycle of pulling or picking. With the right support, recovery is possible.
If you’re ready to take the next step, I invite you to schedule a free 15-minute consultation with me at Ember & Oak Counseling. Together, we can build a plan to help you regain control, reduce shame, and move toward the life you deserve.