We are The TLC Foundation for Body-Focused Repetitive Behaviors, the first and largest organization dedicated to helping people with hair pulling, skin picking, and related disorders. This week is BFRB awareness week. Ask us anything!

Trichotillomaniacs here to represent. What therapeutic approaches have have higher success rates for mitigating the body picking?

Represent! Although I prefer hair-puller :) ComB treatment (Comprehensive Model for Behavioral Treatment) and HRT (Habit Reversal Therapy) have both shown to be effective. Oftentimes, BFRBs can be difficult to treatment because they require many different modules used together from different therapeutic approaches, in addition to pharmacological treatment (for underlying diagnoses such as depression, anxiety, attention-deficit disorder, etc).

Here is an article for ComB: https://www.bfrb.org/component/content/article/231

Other resources can be found on our website, bfrb.org!

Also consider ACT (acceptance and commitment therapy) and DBT (dialectical behavior therapy). These therapies combined can provide strategies are highly effective and can range in success depending on the person!

Hello! My wife picks her skin when she’s nervous (which is all the time). I feel like this is a symptom of anxiety, so I’ve been trying to help her deal with the anxiety. Is this a good way to help her with this, or are there BFRB specific things I could help her with?

Hello! Skin picking disorders can be related to anxiety disorders, but also can exist on their own. As her partner, anything you can do to help her "rev down" her nervous system is great! People with BFRBs don't always know how to help themselves manage their behaviors, so sometimes it is hard to get a straight answer on how to help as their partner. Consider attending TLC's Parent's and Family Support Group online (monthly) to learn more! Thank you for being such a dedicated and caring husband by posting here.

Thanks for the tips! I will check it out!

We also recommend 4 Steps to Melt Urges on the SPOT this FREE 4-part webinar series we systematically work through urges. It’s is a fun, interactive series and you'll learn a powerful tools that you can immediately put to use to find more peace in your mind, your body, and your hands.

I've been plucking at my eyelashes for my entire life. I genuinely like the feeling of when they're plucked, but I immediately regret it when I see my bald eyelids. I also find that when I doing school work, my fingers automatically go up to feel up my eylashes and sometimes pluck. What are some tips and advice for someone like me?

Eyelash puller here! I am well aware of the shame you feel after pulling eyelashes, even if it feels so darn good! Everyone with a BFRB will need dozens of different tools to help them - cognitive tools (like therapy, meditation), behavioral tools (yoga, barriers like bandaids, etc), possibly pharmacological tools, and DEFINITELY peer support. Some barriers I like to prevent pulling my lashes out are wearing eyeglasses, eyeliner (so I won't smudge it), castor oil (very sticky, prevents pulling), and not looking in the mirror AT ALL. I also use Latisse, a drug that is used for glaucoma but has cosmetic benefits for those with trichotillomania because it catalyzes growth of lashes, which I've found helpful.

Hi! I've been a "skin-picker" almost all my life. My parents recall how often my arms and legs were covered in scabs because I wouldn't stop picking. However, my picking moved to my face during middle-school and is something I'm still struggling with today. I'll have good weeks were my face is relatively free of blemishes, but I always end up picking again. I always regret after I pick, but can't seem to stop myself in the moment. Is there any strategies I should try to manage my "relapses" or should I seek out a counseling professional?

Hello!! Relapses are definitely hard to manage, the most important thing you can do is practice being kind to yourself. Fidget tools can be very effective in managing urges. Seeing a counseling professional could help if you feel comfortable talking with someone about your skin picking. Our website BFRB.org has a wide variety of resources on how to manage BFRBs as well as a list of service providers in different areas if you need a recommendation. Thank you for reaching out!

More to say on this in just a moment, but first check out a list of self-help strategies here

Regarding practising self-kindness, there are some great webinars on our website BFRB.org about that topic. Check out Self-compassion and Acceptance - The Building Blocks of Change with Ali Mattu, Phd and Radical Self Acceptance with Kimberley Quinlan, LMFT

Greatly appreciate everything you are doing here! I am wondering how you are able to explore pharmaceutical therapies for BFRB, and what sort of animal models do you use that represent this behavior in humans?

Hi! There isn't a psychiatric drug that helps the majority of people with BFRBs, though some drugs do help a small number of people. Research shows that the most effective nutraceutical is n-acetylcysteine. The only well-developed animal model is in mice, and that information can be read here. Hope that helps!

How much of NAC can be taken to show positive effects?

This depends on your body weight. Please consult your physician or psychiatrist! Especially if you have any pre-existing GI issues.

We also covered the topic of psychiatric drugs in more depth in one of our recent Misconception Monday posts!

Excessive grooming behaviors are also been seen across animal species: Acral Lick Dermatitis – dogs Psychogenic Alopecia – cats Feather Picking Disorder – birds Equine Self-Mutilation Syndrome – horses Barbering - mice

When many people talk about BFRBs, they take care to different them from self-harm. However, some people experience both problems. Is the any information on comorbidity (for lack of a better word, SI being a symptom and not a mental illness), or are there any resources for people with both issues?

Chiming in here too: yes, BFRBs are NOT self-harm (neurologically and clinically) but I understand how it can be confusing because both behaviors can feel pleasurable and addictive. Research is extremely limited in this area because self-harm is usually treated much differently and can be a strong predictor of suicidal ideation/attempts, while BFRBs are not. In general, BFRBs are significantly under-reported due to lack of awareness of them as a condition and the isolation and shame that accompany the condition. I am aware of one online support group that discusses BFRBs and self-harm. I'll check out some more and revisit this post in a bit!

Everyone just tells me just stop, why can’t I just stop?

I'm sorry that you're experiencing that, it's not easy when no one around you understands. BFRBs are not simple habits that we can easily quit, but complex disorders. For more information about BFRBs you can visit the TLC website and you can also access information about treatment and clinicians there. Peer support is very helpful for many people, and TLC hosts monthly online support groups for adults, kids and teens, parents, and men, as well as an online community room every two weeks. You can find groups and register on the upcoming events page of our website.

I am a doctor and *I* just found out that this disorder exists...what are all the BFRBs? I pick extensively around my pubic region, my beard, and I tear my cuticles on hands and feet. Is there a list somewhere?

Hello! Welcome! Love informed doctors! We hear this from people all the time! We say they are the most common disorders that no one has ever heard of. You are not alone! The most common BFRBs are: Excoriation (Skin Picking) Disorder, Trichotillomania (Hair Pulling) Disorder, Nail biting, and Cheek biting. Other BFRBs include (but may not be limited to): Onychophagia – (nail biting), Onychotillomania – (nail picking), Trichophagia - (hair eating), Dermatophagia - (skin eating), Lip Biting, Cheek Biting, Tongue Chewing, and Trichotemnomania - (hair cutting).

Again, welcome! You can go here to Learn About BFRBs

What are the most common causes of BFRD and what is the usual treatment procedure?

Hello! We don't actually know a specific cause. The disorders are related to OCD (classified as obsessive compulsive and related disorders) but have enough differences to not be a type of OCD. Some of the research that has been done has shown there might be a genetic component, but temperament and environmental factors also play a role. The treatment with the most research backing it for BFRBs is cognitive behavioral therapy, especially the subtype habit reversal training. Medication can help as well in some people but it tends not to be as successful as therapy. Thanks so much for asking!

I have picked my lips for my entire life. When they're too raw to continue picking (I can physically no longer grab onto the skin because the top layers are gone) I start picking at whatever little hairs my fingers can find.

Picking my lips has been a pretty big challenge in my life, and people have pointed out when my lips look nasty, but I can't stop. I seem to do it when I'm engrossed in thought, reading, or when I'm nervous.

What is some coping mechanism that you can impart to people in my situation right now that may help? Some little technique you've found to be effective?

There are a lot of coping mechanisms to try. Here is a link to a booklet about treatment, and here is another with self-help strategies. One trick that might help is putting a bad tasting lip balm on (or vaseline) something that might deter you or remind you that you're picking. We have monthly online support groups for adults, kids, and men.

I've found one of the biggest barriers to get over with hair pulling is the shame. The embarrassment when the bald spots begin to show, and the shame that I've done it. But it doesn't deter me, especially when I do it without thinking.

What are some good tools to cope with these feelings, and possibly to hide the damage while you try to overcome the habit?

Hi, you've come to the right place for your question! The shame surrounding picking and pulling is common to almost everyone with BFRBs. And like you said, the shame alone is often not enough to make you stop because BFRBs are complex disorders and involve certain brain pathways that make it impossible to "just stop." Shame can actually fuel your behavior. I have found personally that my behavior reduced as I reached a greater level of acceptance with myself.

Some things to remember are that you are not alone, and you are beautiful! It might sound like a cliche but your appearance does not define you and I'm sure you have so much more to offer than your hair!! Every single person has flaws, yet it so easy to get into your own head. Other people are way less likely to notice your bald spots or flaws than you are. If you want to work on overcoming the shame and/or this behavior, I strongly encourage you to attend our support groups (in-person and online).

Are there any strategies for lip biting? I enjoy the sensation and sometimes don't even notice I'm doing it until it's too late and I'm bleeding.

First, ensure the behavior is consciously observed. Second, work on strategies to change the behavior. The trick is to train yourself to notice the anticipatory signals that you are about to bite your cheek. This can be as simple as thinking to yourself, "I feel like I might bite," or "I am biting." Another strategy is to keep track of the behavior by journaling when the behavior occurs. Think about whether the behavior was triggered by an event, and what feelings were associated with it. By labeling the behavior and the emotions associated with it, we can move the behavior into our consciousness and increase our chances of regulating it. For an in-depth overview of treatment guidelines and considerations for BFRBs, download our free booklet,

Also, when you said that you don't always realise/notice that you are engaging in your BFRB behaviour, you are not alone! Research has identified 2 types of BFRB behavior: (1) automatic, when it is done outside of conscious awareness; and (2) focused, when we are aware of the behaviour. Most people report engaging in both types to some degree.

Also, we have a ton of educational events and support groups - people often find support groups to be helpful

Hello! Deeply appreciate this, while I've been a picker and hair puller for most of my life, I had no idea there was a whole foundatin trying to help people like me!

My question is... Is there any current research into using psilocybin or other psycho-active drug therapy for treatment? I thought I read recently that there is connection to treating repetitive behaviors with them but can't remember the study.

Thanks for this question! The use of psilocybin and even MDMA has definitely been used in scientific research, but no such studies exist specifically linking improvement of BFRB symptoms following administration of psilocybin. There is a large body of research linking it to treatment for PTSD, depression, and improvement in quality of life for those with terminal illnesses. Also, there is a study examining psilocybin's effectiveness with OCD as many anecdotal posts from users on reddit regarding microdosing such as this one. To our knowledge, there has been no such published studies in peer-reviewed journals suggesting a link.

The scientific community doesn't yet have enough knowledge on this topic to suggest an indication for BFRB treatment with psilocybin. MAPS is a great non-profit research and educational organization developing medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana for many different disorders.

Long term hair puller here. I understand this is an under researched condition. Are there any ways we can contribute to the research of BFRBs? I know we can always donate but are there any studies going on that we could participate in?

You can donate toward the research that TLC organizes here!

Hi! Participation in research is one of the best ways to have an active role in the community. We keep a listing of research studies open to enrollment on our website. There are also usually studies taking place outside of TLC that you can find on places like www.clinicaltrials.gov or Amazon mTurk. Hope this helps!

I'm fed up with people saying things like "you're pulling because you're stressed" or "stopping pulling should take the same willpower as quitting smoking and people manage that". How can I explain things like this and bust the myths?

Here are some correct answers to common misconceptions that people have about BFRBs. We host misconception monday most monday's on our instagram that provide research into why the misconception is wrong.

-BFRBS are not a new phenomena

-BFRBs are not the result of poorly managed anxiety

-BFRBs are not a sign of serious mental illness

-BFRBs are not self-mutilation or non-suicidal self-injury

-BFRBs are not typically associated with childhood trauma, maltreatment, or abuse

-BFRBs are not a simple habit that can be easily stopped

-BFRBs are not a form of OCD

-BFRBs do not respond well to antidepressants (SSRIs)

-There are good treatments for BFRBs

Also, with regard to smoking, most people require some level of interventional therapy whether it is medication or therapy to quit smoking.

Willpower also has a lot of interesting research around it and if it actually exists or is usable in the way we often refer to it.

It's so great to get confirmation that BFRBs are not the result of stress. I am one of the happiest, most relaxed and content people, but have struggled with trich since 2nd grade. It's not at all linked to anxiety for me, and it gets tiring to hear that it's related from people who don't know anything about it. If anything, I'm learning that I probably have ADD (I'm a high-functioning adult, and it's a well managed inattentive version) and would love to learn more about the link between BFRBs and ADD. My child's pediatrician says that anecdotally, she sees these traits shared very often. I think it must be the hit of adrenaline or dopamine I get from pulling an eyelash.

A previous question in the AMA asked about BFRB and ADHD comorbidity and the disorders do co-occur 23.5% in skin picking and 29% in hair pulling. There seem to be many different subtypes of pulling, this study showed 4 subtypes, one of which did not have anxiety/tension as a trigger, it's only trigger was boredom. From what I know about ADD and ADHD is that the brain needs extra stimulation, so pulling/picking/bfrbing may provide that stimulation.

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Check out our friends at BFRB.Brasil!

That's...that's actually wonderful. Thank you so much!

I've been fighting this for 14 years and actually doing great now (no pulling for the last 7 months), but it's always important to keep up with the community.

AWESOME!! Also, you can keep up with us here!

Hi, I'm 31 years old now and have been hair pulling since I was around 9 years old. My parents did not take me for any sort of mental health care when I was a child due to a combination of poverty and religious fundamentalist. When i was 25 or so I finally started getting control of my own life, but therapeutic and medicinal approaches to my hair pulling have not been effective. I'll be honest...I hate myself and am full of rage against my parents for not helping me and against myself for being unable to control it which leads into a deep spiral of helplessness, despair, and anguish. Yes i go to therapy, but it isn't all that helpful. It just feels too late. What should I tell myself?

OH! There are SO many things I want to say to you! But mostly, what I need to say and I hope you hear, is that I am SO SORRY! You deserve better. To me you sound like a total warrior! You’ve made it this far and you are here so that means something! What I also want to say is that you are already loved, deeply, by the TLC community! You may think that’s just being flowery, but it’s not. That is the amazing thing about the BFRB community - we are always ready to meet and greet fellow BFRBers with open arms and hearts. Welcome! When it comes to what you should say to yourself, that’s tough. It is not an easy journey you are on. But, we are here with you! I’m going to recommend some things to watch that may HOPEFULLY guide you farther along the way to easing your pain: Self-Compassion and Acceptance - The Building Blocks of Change and Radical Self Acceptance These are a great place to start because you can watch them in your own time in a safe place and then after you get to a place where you feel more comfortable I recommend that you join a TLC Online Support Group. The groups are an amazing place to meet fellow BFRBers who can help. In the meantime tho, I recommend you try to be cognizant of your thoughts and when they get negative - take note of it. Try and stop. Try and reframe. For example when you hear “I’m so dumb” coming from your own brain try and stop and instead think “I am trying”. It sounds cheesy! But it works. One teeny tiny step at a time. Love to you. Wishing you restful hands and a peaceful heart! Check out [bfrb.org](www.bfrb.org) We are here for you!

Chiming back in here again. Going off what u/lovebyletters said about not all therapists being equal, that is absolutely true. If you are interested in finding a different therapist, we have a directory of clinicians who have experience and/or training in treating BFRBs. If you can't find one on that list looking for therapists who specialize in treating OCD is also good since BFRBs are related to OCD. Your journey isn't over and it's never too late.

Hi, I pull pretty bad around my pubic area and have scarring. It makes it awkward when meeting partners. I'm pretty open about my trich otherwise but this one, well, it's embarrassing. Any tips on explaining this to partners (if ever get one again!?)

Also, this is for skin picking, but this is a lovely article - Five Things - I Want My Future Partner to Know About Skin Picking

First of all, you deserve a loving relationship! However, that often involves cultivating a more loving relationship with yourself first! And oof! That’s hard! Sometimes having a BFRB can make it seem even harder to find self love. This webinar about Radical Self Acceptance can be a great place to start down your path towards that good-good BFRB-self-love! I pull from my pubic region as well, and it isn’t always pretty. While we don’t encourage people to shout from the rooftops about their BFRBs, we do think it is a good idea to let your partner know that BFRBs alone aren’t fatal, and they certainly aren’t your fault. You can suggest an analogous example such as “you wouldn’t tell someone who is diabetic to just start producing their own insulin, would you?”. A lot of people think that we are inflicting this on ourselves, when it may just be a highly sensitive and fluctuating nervous system that takes a long time to learn about and manage. If your partner doesn’t seem receptive to being compassionate and supportive, you may have a different issue to deal with 😊

I have a hard time telling people I am dating, or want to consider dating seriously. I just tell them I have it very nonchalantly and act surprised when they don't know what it is. You can follow it up by asking if they know anyone that bites their nails or pulls their hair, and then pretend to be super surprised when they have no idea what you're talking about! Link them to bfrb.org if you don't want to dive deeper into the conversation.

What do we know about the comorbidity between BFRBs and ADHD?

Co-occurring disorders are very common with excoriation disorder and trichotillomania.

Excoriation disorder/dermatillomania:

In a retrospective review of 250 cases form a tertiary care center, 74% had one or more co-occurring disorder: depression (42%), anxiety (29%) substance use disorder (16%), bipolar disorder (8%), ADHD (6%) OCD (5%), PTSD (3%) (Kwon et al. 2020). In a survey of 213 adults with excoriation disorder, 63.4% endorsed generalized anxiety disorder, 53.1% depression, 27.7% panic disorder, 27.2& PTSD, 26.3% OCD, 23.5% ADHD, 19.3% eating disorder, 16% alcohol or drug abuse, 12.7% trichotillomania, 12.2% bipolar disorder, 7% tic disorder (Grant & Chamberlain, 2020).

Trichotillomania:

Research suggests that 55% - 79% of adults with TTM have one or more co-occurring disorder (Woods et al., 2006; Grant, Dougherty, & Chamberlain, 2020). In a survey of 1,697 individuals with TTM, 26% endorsed OCD, 23% endorsed major depression, 23% endorsed generalized anxiety (Woods et al., 2006). In a survey of 10,169 US adults with TTM, 55% endorsed anxiety, 43% depression, 29% OCD, 29% ADHD, 29% PTSD, 25% panic disorder, 24% skin picking, 19% bipolar disorder, 18% drug/alcohol abuse, 17% eating disorder, 8% tic disorder (Grant, Dougherty, & Chamberlain, 2020).

For more information about comorbidities, check out this 2016 study "Comorbidity and quality of life in adults with hair pulling disorder" by Houghton et al. and the 2020 study "Epidemiology and Comorbidities of Excoriation Disorder: A Retrospective Case-Control Study" by Kwon et al.

Nail-biting seems a lot more widespread than hair-pulling or skin-picking. Do we know if it really is, or if people just hide it more?

There are different "levels" of all BFRBs. Nail biting is more socially acceptable, and a lot more people do it at a subclinical level where it doesn't negatively impact their life. To be considered a BFRB the behavior negatively impacts the person's life and the behavior has a compulsive aspect. More information on nail biting is available here. It is definitely possible that hair pulling and skin picking are underreported (right now research is showing about 2% of people).

Chiming in here, nail biting is very prevalent, but more so it is socially accepted. We know the numbers behind BFRBs are low because the conditions are under-reported and sometimes easier to hide. Researchers and those with BFRBs know that more people have them, but it is difficult to get funding to study them because they aren't life-threatening. Reducing the stigma around these behaviors and that it isn't the person's fault (they can't JUST stop), educating clinicians, providing peer support, and funding research is just one of the ways that TLC aims to better represent the suffering incurred by BFRBs - both in the literature and in someone's everyday life.

Hi, I saw you offered some advice regarding eyelash pulling (thank you). I personally also am an eyebrow puller and was wondering if you had any advice in that regard? Due to working from home and this year's stressors, I have virtually no eyebrows left! (Now the eyelashes are almost fully disappearing too.) Also thank you for doing this AMA!!

Hi! We have a collection of tips and tricks here. Personally I like to always have fidget toys around me (I love the tangle jr.'s, they're available on amazon for pretty cheap). Putting tape on the tip of the fingers you use to pull is also helpful. We also host monthly online support groups and a biweekly community room (here is the link to our events page where you can register for support groups or other events).

Hi! Long term hair puller here. I went to a TLC conference back in 2002 (I think?) and had such a great time! I know with COVID conferences likely aren’t being held but I have always thought about going back to one. Not only did I get so much out of the workshops, but it was the first time I had ever met anyone else who had a BFRB (of course that I knew of)...

Are these conferences still happening? I would love to be a part of them again when we can all safely be around each other again!

Hi! We do still have annual conferences every spring. This upcoming spring we are still undecided if the conference will happen in person (if so it will be in Houston April 8-12). This past spring we had a virtual conference and here is a link to all the webinars. Hopefully we will be able to see you this spring!

We have HUGE online support groups and you are most welcome to connect with our community there too.

I have BFRBs and I find that fidget toys often help to prevent or replace my skin picking. However, when I'm in public or at school, I don't feel comfortable carrying a fidget toy around with me. Do you have any suggestions?

Hello! A fidget toy doesn't necessarily have to be made for that purpose. You can turn many ordinary objects into discreet fidget toys. For example, you can try holding a pen or pencil and clicking it or rubbing the eraser. You can put a rubber grip around it and twist or rub it. You can also try wearing loose jewelry. Twisting rings on your fingers or moving the charm on a necklace is discreet and something you can easily do while in public. You can try other methods of keeping your hands busy such as sketching/drawing, knitting, or writing while on public transportation, for example. Hope this helps!

Hi there! Thanks for doing this AMA and raising awareness. I am not typical when it comes to my hair pulling since I don't pull common areas like my head hair, eyelashes or eyebrows. Instead I pull hair from my chin and from my stomach. Do you have any specific tips for managing pulling in those areas?

Hi! People will pull from pretty much any place on the body that has hair so there is most likely someone else out there (like me!) who pulls from the same areas. A lot of the tips for managing pulling in those areas can be similar to the common areas and we have a collection of them on our website. Two things I personally do is make sure I don't have tweezers around and to tuck my shirt into my pants to make it difficult to reach my stomach to pull. Also, if you are a woman and have chin hairs growing (especially if they are dark), I would consider talking to your doctor because it could be a sign of something hormonal.

Thank you! I will look at that collection - it looks very useful! The tucking shirt into pants idea is good. I am a woman and I have some chin hairs growing but not a lot. Before I pulled them they used to be light and thin but now that I pulled them some of them come out as more thick and dark. Do you have any insight regarding that?

Personally mine always started out dark and thick so I'm not sure in your case, maybe it grows back differently. I also have heard its more common as women age to start getting a few darker chin hairs. I wouldn't worry if there aren't many growing but if it does worry you a doctor can run blood tests that would check for hormonal changes.

Hi! I found out last year that hair pulling is an actual thing and has a name (god bless Google). I went to my doctor but they had never heard of it and suggested that I try an anti-depressant. I'm not depressed though so I didn't take it (OK, i get sad sometimes, but I don't only pull when I'm sad - it happens across so many situations and sometimes I don't even realise I'm doing it). Why don't doctors seem to know about this? Or why don't they understand more about it?

Hello again! If you are looking for a drug treatment but don't feel like anti-depressants are right for you, there is an over the counter drug called N-acetylcysteine (NAC) that can help treat BFRBs in some people. You can read more about NAC here: https://www.bfrb.org/component/content/article/3-treatment/123-n-acetylcysteine-for-trichotillomania-skin-picking-and-nail-biting.

There is also still a lot we have to learn about BFRBs. They are relatively new compared to other disorders. Trichotillomania wasn't added to the DSM-5 until 1987, and excoriation disorder wasn't recognized until 2013. As such, they are not as heavily researched as other disorders, and are less frequently taught to medical professionals, students, or even hair dressers. That's why at TLC we try to spread awareness and offer support! We also have a BFRB Awareness week (which this Reddit forum is part of) every year and hold annual conference.

Hi! I'm sorry your doctor didn't know about it. Unfortunately BFRBs are often not covered in medical school or are only a short part of the curriculum (most schools are getting a little better about this in recent years). Anti depressants actually treat disorders outside of depression like anxiety and OCD (and BFRBs are related to OCD). Sometimes anti-depressants can help reduce pulling or reduce the anxiety that leads to pulling. Currently, the treatment with the most evidence is cognitive behavioral therapy (link to information about treatment). We also have a list of clinicians who are trained in treating BFRBs, and monthly online support groups.

Hi! I have picked at my skin since I was a teenager. I told someone once and they told me it was weird and disgusting. I'm now afraid to tell people. How should I know who to tell or should I just keep it a secret?

Hello! Although picking at yourself might seem gross or weird, you are probably the only one thinking that! Most times other people don't even notice. In addition, BFRBs including skin picking are actually very common. It's estimated that 1 in 25 people have a BFRB, or 3-5% of the population. And there are even more people who pick at their skin, nails, hair, etc. even if it is not severe enough to be considered a disorder.

As for telling people, you are in control of your own narrative and you can choose who you tell and what you tell them. Don't feel compelled to share with everyone if you don't want to. We recommend telling someone you trust and who you feel comfortable around. If you are ever asked about it and don't feel comfortable giving them a full answer, feel free to lie, be vague, change the subject, or refer them to bfrb.org for more information.

Hey, thanks for doing this AMA! I’ve been a skin picker most of my life. I also have Tourette’s syndrome, and I remember being told that the skin picking is just another of my tics. I just wanted to ask you if skin picking could also be a BFRB even though it’s brought on by Tourette’s?

Hi, thanks for asking a question! Tourette's syndrome and skin picking have research showing associations between the two, but they are two distinct disorders. BFRBs are a type of obsessive compulsive and related disorder. Skin picking related to tourette's could be a BFRB and separate from your Tourette's (we are not doctors or clinicians so we obviously can't say for sure in your case). Here is a link to a study that shows increased rates of BFRBs.

Does this include nail biting?

Nail biting, or onychophagia, is in fact a Body Focused Repetitive Behavior (BFRB). You can read about it here. Please remember that there are varying degrees of all BFRBs. Diagnostic criteria include: Repeated attempts to stop the behavior; the symptoms cause clinically significant distress or impairment; the symptoms are not caused by a substance or medical, or dermatological condition; and the symptoms are not better explained by another psychiatric disorder.

Hi, I’ve been picking at my skin since I can remember. When I was younger and had no issues with my skin it was just scabs I would pick at and never let heal, but now that I’m older and I get acne it is so much worse. I pick on my entire body and it looks like I have constant chicken-pocs. I’m still in highschool so I was wondering how common it is for someone my age to have such severe picking? Yesterday for example, all together I probably spent at least 4 hours picking.

Hi! Being in high school with a BFRB is a pain. There are definitely many other people like you out in our community (BFRBs often start in adolescence). If you're interested in meeting other pickers and BFRBers we have biweekly community rooms and monthly online support groups. We also have a directory of local support groups (most are online right now because of COVID). As u/Chihuahua_enthusiast said, we have an annual conference where there are lots of high schoolers (we're unsure if this year's will be in person, but if it is it'll be in houston). Check out our friends at the Picking Me Foundation they have great resources just for picking and we love them very much. If you want more specialized help to stop or decrease your picking, therapy is the most effective method and we have a list of therapists/clinicians who have experience and/or training treating BFRBs. We're all in this journey together!

Hello, my boyfriend chews at his finger tips. Like pulling skin off until its painful and bleeding kind of picking. He only ever does it that badly when he's playing video games (a big hobby and passion of his he takes great pride and fun from). I'll even mention to him to stop whenever he gets going but he almost instantly puts his finger back in his mouth. He doesn't like it and is self conscious about his fingers.

I wonder what this could be exactly and if I could be doing something more effective than just bringing his attention more to his fingers instead of the game he's lost in?

Research shows that there are at least two subtypes of BFRBs, ones that happen consciously (focused) or unconsciously (automatic), and people can do both. One of the best ways to try and decrease automatic BFRB is to bring awareness to the behavior. If he's ok with you pointing it out to him, continue doing that. Another thing that may help is finding a bracelet or something that makes noise when he reaches up to his face, or putting something heavily scented or bad tasting on the fingers. We have a collection of other self-help tips here. You're an amazing partner for being so supportive and wanting to help him!