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Short answer: Trichotillomania (hair-pulling) and excoriation disorder (skin-picking, sometimes called dermatillomania) belong to a group of difficulties called body-focused repetitive behaviours, or BFRBs. They are more common than many people realise, they are not a sign of weakness or a wish to harm oneself, and there is real, practical help.
What BFRBs Are — and Are Not
BFRBs are repeated behaviours directed at the body — pulling out hair, picking at skin, and sometimes nail- or cheek-biting — that the person has often tried many times to reduce or stop. They are not usually a form of self-harm in the sense of trying to cause pain, and they are not attention-seeking. People often pull or pick in private and feel a good deal of shame, which is one reason the difficulty can stay hidden for years. Many describe the behaviour as soothing, satisfying, or simply automatic.
How They Differ From OCD
Trichotillomania and skin-picking disorder are grouped with obsessive-compulsive and related disorders, but they differ from OCD in an important way. In OCD, a compulsion is usually driven by an intrusive thought and the urge to reduce anxiety or prevent a feared outcome. In BFRBs there is often no such feared thought: the behaviour may be triggered by tension, boredom, tiredness, concentration, or the feel of a particular hair or patch of skin, and it can bring relief or reward. This difference matters, because the most helpful approaches are not the same as those used for classic OCD.
What Can Help
The goal is usually steady reduction and better quality of life rather than a guaranteed instant stop. Habit Reversal Training (HRT) is one of the better-studied behavioural approaches: building awareness of when and where the behaviour happens, noticing the urges and early movements, and learning a competing response — something to do with the hands that is incompatible with pulling or picking — alongside changes to high-risk situations. A broader framework, the Comprehensive Behavioural (ComB) model, tailors strategies to each person’s particular triggers. Evidence for ComB is promising but still developing, so it should be used as a structured clinical framework rather than a guaranteed method.
- Track when pulling or picking happens, what came just before, and how you felt — without judging yourself for what you find.
- Reduce easy access during high-risk activities, and adjust lighting or triggers where you can.
- Treat yourself with kindness rather than punishment: shame raises tension, and tension tends to increase the behaviour.
- Look after sleep, stress, and emotional load, because BFRBs often rise when a person is depleted.
How Psychotherapy and Counselling Can Help
A therapist can support habit-reversal and ComB-style strategies, help make sense of the feelings and situations that fuel the behaviour, and work with the shame and secrecy that so often accompany it. Because BFRBs overlap with anxiety, stress, and self-criticism, the work frequently connects with those areas too. The approach is collaborative, paced, and non-judgemental.
It is worth seeking support if the behaviour is causing hair loss or skin damage, taking up significant time, affecting your mood, relationships, or daily life, or leaving you feeling stuck despite your best efforts. If skin-picking has led to wounds that are infected or not healing, please have them seen by a GP. For trustworthy information, the TLC Foundation for Body-Focused Repetitive Behaviors is a good starting point alongside professional support.
Related Pages
- Obsessive-compulsive disorder (OCD)
- OCD types, themes and questions
- OCD therapy in Dublin and online
- Anxiety
- Self-compassion
- Make an appointment
- How this mental health information is written and reviewed
- Disclaimer
Sources and review. Published in June 2026. This page is educational and uses public-health, peer-reviewed, professional, or recognised-model sources where claims are made. It is reviewed and maintained by the practice.