Skin Picking and Hair Pulling Explained. What are Body Focused Repetitive Behaviors?

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The two most common behaviors are hair pulling and skin picking. These two have official names in the diagnostic manual. Hair pulling is called trichotillomania and skin-picking is called excoriation disorder. Even though trichotillomania has mania in the name, it has nothing to do with the mania of bipolar disorder.

Some other body focused repetitive disorders include:
Nail biting also called Onychotillomania
Lip biting
Nose picking

Some of the therapies used to help this condition are habit reversal training, which is a type of cognitive behavior therapy and a self-help technique called decoupling. With decoupling, you perform a different behavior whenever you feel the tension that normally triggers the compulsion. The idea is that this other behavior that you do, decouples or disrupts the connection between the emotion and the compulsion. Engaging in the other behavior allows you to gain some control over the compulsive behavior.

We don’t have any medications that are standardly used for this disorder. There’s been some evidence that inositol and N-acetylcysteine have been helpful. Both of these are supplements that you can get without a prescription. Other alternative therapies are yoga, aerobic exercise, acupuncture, biofeedback and hypnosis.

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Grant JE, Odlaug BL, Chamberlain SR, et al: Skin picking disorder. Am J Psychiatry 169(11): 1143–1149, 2012 PubMed ID: 23128921

Moritz S, Rufer M. Movement decoupling: A self-help intervention for the treatment of trichotillomania. J Behav Ther Exp Psychiatry. 2011 Mar;42(1): 74-80. doi: 10.1016/j.jbtep.2010.07.001. Epub 2010 Jul 14. PMID: 20674888.

Torales J, Barrios I, Villalba J. Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update. Adv Mind Body Med. 2017 Winter;31(1): 10-13. PMID: 28183072.

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