Body-Focused Repetitive Behaviors (BFRBs)

EXCORIATION DISORDER

COMPULSIVE SKIN-PICKING

Excoriation Disorder (aka Dermatillomania) is another type of BFRB. Those with Dermatillomania, also called “Derm” for short, pick their skin to the point of causing lesions. Even though it is not often talked about, this disorder is not at all uncommon. In fact, a study found that 2.1% of 10,169 adults struggle from this disorder. When someone is struggling with compulsive skin picking, they have difficulty stopping despite adverse effects as well as attempts to stop.

As with TTM, people with Dermatillomania often find picking to be soothing and satisfying. Thus, while this behavior may appear to be a form of self-mutilation, those with compulsive skin-picking  generally do not pick as a means of self-harm. People may pick for many reasons – for example, to make their skin smooth or to achieve some other sensory experience. They may pick to perfect their skin, even when their efforts rarely lead to improvements and more often create damage. People with Dermatillomania also pick to manage uncomfortable emotions or to promote focus and quiet the mind. Excoriation Disorder is often perpetuated as a result of associations with certain locations and postural poses that contribute to the habit. Some will even pick in order to manage anxiety caused by picking.

DIAGNOSIS OF AND THERAPY FOR BFRBs

DIAGNOSIS OF BFRBS

Since most people do pull hairs from time to time, it’s important to note that those with TTM must experience distress or impairments as a result of their pulling. Oftentimes, people experience a great deal of shame because of bald spots that occur. In fact, people may avoid social situations because of their fear of judgment. In addition, those with Trichotillomania may pull in spite of physical pain or discomfort. Pulling can also be time consuming. Many individuals get lost for long periods of time pulling in trance-like states.

Likewise, most people pick their skin to some degree, but those with compulsive skin-picking, experience significant distress or impairment in functioning as a result of their picking. Individuals with the disorder may, for example, avoid social settings and even responsibilities after a significant episode of picking. Many also lose large chunks of time while picking in trance-like states. While living with this disorder can be very challenging, there is help available.

This can be an incredibly distressing disorder to live with, but there is help. If you or someone you know is struggling, you can read more about evidence-based Therapy for BFRBs here.

THERAPY FOR BFRBs

ComB

The ComB approach addresses many reasons people pick. The treatment identifies five reasons people pick using an acronym, SCAMP: Sensory, Cognitive, Affective, Motor and Place. In this therapy, people log when they do their BFRB and what motivated the behavior. Once someone knows which domain triggers the desire to pick, they can support themselves in a way that meets their specific needs. Someone who’s triggered when they feel a blemish might wear tape on their fingers. This can act as a barrier and prevent triggers. If the bathroom mirror is a trigger, a person might set a timer before going to the restroom to support awareness.

HRT

HRT also involves logging. That said, the main intervention, competing response training, is mostly meant to interfere with the ability to pick. In competing response training, people learn to tense their muscles in a way that precludes picking for one minute when the urge to pick arises. HRT Plus is a term used to describe traditional HRT with the addition of other approaches. Habit blockers, stimulation replacements and stimulus control are all incorporated into HRT Plus.

You can learn more about ComB and HRT here.