Why Body-Focused Repetitive Behavoirs Can Be So Darn

Have you ever popped a pimple? Not methodically, with planning and gloved hands and clean gauze and adequate light. I’m talking about the pimples you pop because they feel urgent—the moments when you’re at your desk and feel a teeny bump on your cheek that shouldn’t be there, head to the bathroom to inspect it, and end up clawing it out with your fingernails. Even though you know it will leave a mark later, when you do pop it there’s an “ahh, that’s better” release that can be addictive when you need a way to cope with something stressful in the moment. Skin picking is an example of a body-focused repetitive behavior, or BFRB, which is a fairly new category in the field of psychology. (More traditionally, BFRBs would be classified under Obsessive Compulsive Disorder.) Still, if you’ve ever felt that uncontrollable urge to pop a pimple even when you know you shouldn’t, you can relate to a different, less common BFRB condition called trichotillomania.

“Trichotillomania is a debilitating and frustrating condition that causes people to compulsively rip out hair from their scalp, body, eyebrows, and eyelashes,” explains neuropsychologist and Columbia University professor Dr. Sanam Hafeez. Some studies have noted what appears to be an overlap between trichotillomania and skin picking (24-percent of participants in this study experienced both physical tics). And other researchers have noticed an increase in those numbers due to the COVID-19 pandemic—this study notes that a whopping 67-percent of participants experienced an increase in both BFRB urges during this time. Much like skin picking when you’re stressed, a rise in anxiety can correspond with increased urges to pull.

Sometimes it’s described as a feeling of hyper-fixation on a hair that feels particularly wrong; other times, folks describe the feeling like unconsciously scratching an itch—they might not even realize they’ve been pulling until a pile of hairs has built up beside them. Either way, explains Dr. Hafeez, “Those with this disorder feel a wave of relief after they rip out their hair, which causes them to continue with the vicious cycle of hair pulling.” She also adds that there’s no one specific underlying cause of trichotillomania, or trich (said like “trick”) for short. Urges usually start popping up in the early teen years, and despite equal distribution reported among boys and girls in childhood, Dr. Hafeez adds that trich seems to affect “substantially more” women than men through adulthood.

The extra stress of hiding bald spots caused by trich (or explaining them to strangers) can intensify the anxiety that triggers urges in the first place. And if you know, you know:the solution isn’t as simple as “just don’t pull.” Resisting the urge to pull, without help developing other coping mechanisms, can feel like “[trying] to hold a sneeze in… forever.” And who wants to do that?

In addition to the psychological weight of trich, it has very real physical effects that go beyond aesthetics. First of all, repeatedly pulling out your hairs can cause permanent damage to their roots. “Over time, people with trichotillomania see changes in their hair shafts,” says board-certified dermatologist Dr. Morgan Rabach. “The hair grows back thinner and distorted, and it has a shorter growth phase compared to resting phases.” Repeated damage to the root in this way means that, at some point, the hair won’t grow back anymore. Additionally, open wounds caused by pulling hairs can become infected, and need serious medical attention. “To avoid permanent hair loss or infection it is important to seek help from a therapist for even minor trichotillomania,” adds Dr. Hafeez, who notes that while it’s great if you can manage your trich on your own, it’s rare that the condition resolves itself without proper support. You can start by perusing the TLC Foundation, which has a database of over 300 therapists specializing in trich treatment.

Much like how covering zits with pimple patches can prevent you from picking, covering your fingers or pull sites can help keep your hands off of them. Similarly, custom-fit extensions can act as a barrier between your fingers and your scalp—in New York, hairstylist Sheila Chung fits her trichotillomania clients with hair pieces that give the look of naturally dense hair while protecting new growth. You can also try using a stress ring, which is moveable jewelry to fidget with when you have an urge. They can be as cheap as 11 bucks and expensive as $1,300. (This comprehensive list of trich management techniques comes from another Subreddit community on the topic, if you’re looking for more.) “I’ve had trichotillomania since elementary school,” shared beauty editor and Starface founder Julie Schott in her Top Shelf, adding that she has “a rotating system of things that help me not pull [my brows and eyelashes] out.”

And once your trich is managed, you can focus on growing new hairs. You can cover up bald spots with eyebrow powder or root touch-up spray, or even try a set of false lashes. (Loveseen’s are made with folks who don’t have natural lashes in mind.) For lashes, Dr. Rabach also suggests trying Latisse. “The active ingredient is a prostaglandin analogue, which helps grow hair back faster.” Or, you can lean into what you already have by shaving your head completely, and emphasizing bare lids with colorful liner.

—Ali Oshinsky

Photo via ITG

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