Trichotillomania Symptoms


Hair Pulling and Skin Picking, part 1.
Hair Pulling and Skin Picking, part 1.


People with Body Focused Repetitive Behaviors like trichotillomania (hair pulling) or dermatillomania (skin picking) are often afraid that others will think they are “weird”. They feel ashamed and keep the behavior a secret.

The Trichotillomania Learning Center is breaking silence about these problems.  Their website, , is full of helpful information.  It’s aimed at bringing hope to those suffering from the disorders, and training to mental health professionals.

In the past, these problems were often regarded as “just habits”, not a significant source of distress or life impairment.  Alternatively, some professionals saw them as indications of “deeper” psychological problems. BFRBs were poorly researched until quite recently.  We don’t even know how many people will experience them. One study found that 1.5 % of male and 3.6 percent of female college students suffer from trichotillomania, and the numbers may be even higher for other BFRBs.  More research is needed on these disorders.

Surveys indicate that many people with BFRBs have never  been diagnosed.  “Talk therapy” is not effective for BFRBs.   It’s true that BFRBs, like anxiety, are problems that good treatment teaches people to manage rather than overcome forever.  But being able to manage a problem feels so much better than being overwhelmed by it!

In this first episode, we will be looking at possible causes for BFRBs.  Treatment will be discussed in a later blog.

It is not true that BFRBs are just symptoms related to inner conflicts.  Many factors play a role in the development of a BFRB.   The visible results of the BFRB are themselves a significant stressor.

Studies of twins indicate that there’s a genetic basis to BFRBs.  Twins who developed from the same embryo are much more likely to both have a BFRB than twins who developed from different embryos.  DNA testing is being done on people with BFRBs.

It’s interesting that animals, including dogs, cats, horses and birds, can develop behaviors that mimic BFRBs.  For example, a bird moved to a different cage may experience stress and beginning pulling out its feathers.

BFRBs may be linked to imbalances in some brain chemicals, such as serotonin (which can be regulated by antidepressants) or natural opiates that originate within the body.

There’s some evidence that people with BFRBs have biological difficulties in regulating their degree of arousal.  They may find it very difficult be in boring, unstimulating situations such as driving, and “automatically” pull or pick, without even being aware of doing it.  The pulling stimulates the fingertips, which have lots of nerve endings.    People with BFRBs may also consciously pull or pick when overstimulated by stress, to calm themselves.  This is called “focused” picking.  Most people with BRFBs do both types of picking, though one may predominate.

Many people with BFRBs find that the pulling or picking is pleasurable and reduces tension they felt previously  However, feelings of shame and regret often arise once the picking is over.

Another important aspect of BFRBs  is the association of the behavior with certain places and activities.  A teen who pulls while doing his homework at his desk may come to associate the desk with pulling, so that sitting down there becomes a powerful “trigger”.

One treatment for BFRBs that focuses on changing behavior is called “Habit Reversal Training.”  However, Drs Charles Mansueto and Fred Penzel, and Ruth Golumb, have developed a more comprehensive behavioral treatment,  COMB.    It helps people make changes in different areas that contribute to and maintain the problem – ,managing physical sensations, thoughts and  emotions and the physical environment. This will be discussed next time.