Trichotillomania and Excoriation Disorder (Hair Pulling Disorder and Skin Picking Disorder)

What is Trichotillomania (Hair pulling) and Excoriation Disorder (Skin Picking)?

Trichotillomania and Excoriation Disorder are listed in the DSM V as subtypes of OCD or Obsessive-Compulsive Disorder. Hair pulling and skin picking are repetitive self-grooming behaviors in which pulling, picking, biting or scraping of the hair, skin or nails result in damage to the body. Common Body Focused Repetitive Behaviors or BFRBs include skin picking (of scabs, acne, or other skin imperfections, for example), cuticle or nail biting or picking and lip or cheek biting. These behaviors share similar characteristics.  The urges can be very powerful and difficult to stop. They can be “unconscious” movements while reading, talking on the phone, watching TV or engaging in some other activity. Or there may be times when BFRBs are done in a fully focused way, for example when pulling out a hair that “doesn’t feel right” or picking a scab while looking at it in the mirror.  Some people engage in BFRBs when they are bored or to control their emotions when they are feeling anxious, tense or upset. Specifics of BFRBs will vary between individuals.

What are the symptoms of Trichotillomania (Hair pulling)?

  1. Recurrent pulling out of one’s hair, resulting in hair loss. Hair pulling may occur from any part of the body where hair grows.
  2. Repeated attempts to decrease or stop hair pulling.
  3. The hair pulling causes clinically significant distress or impairment in social, occupation or other areas of functioning. This could include attempts to hide it, avoidance of certain situations, feeling a loss of control, embarrassment or shame as well as the fear of what others might think if they knew.

What are the symptoms of Excoriation Disorder (Skin Picking)?

  1. Recurrent skin picking resulting in skin lesions.
  2. Repeated attempts to decrease or stop skin picking.
  3. The skin picking causes clinically significant distress or impairment in social, occupation or other areas of functioning. This could include attempts to hide it, avoidance of certain situations, feeling a loss of control, embarrassment or shame as well as the fear of what others might think if they knew.

What are the causes of Trichotillomania (Hair pulling) and Excoriation Disorder (Skin Picking) and other body-focused repetitive behaviors?

There is no one identified cause of BFRBs, Trichotillomania (Hair pulling) and Excoriation Disorder (Skin Picking). It may develop due to a combination of genetic, emotional and environmental factors. There is a correlation with having OCD as well as having family members with OCD.

How can you treat Trichotillomania (Hair pulling) and Excoriation Disorder (Skin Picking) and other body-focused repetitive behaviors?

Dr. Dufford and Anxiety Treatment Services provide integrative and comprehensive individual therapy for Trichotillomania (Hair pulling) and Excoriation Disorder (Skin Picking) and other body-focused repetitive behaviors.  Modalities include Cognitive-Behavioral Therapy including Habit Reversal Training (HRT), Hypnotherapy, Energy Psychology, and Meditation/Mindfulness. Since BFRB issues will vary from person to person, Dr. Dufford evaluates each case and creates an individualized treatment plan for that person’s unique situation.

 

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