In middle school, hormones are raging, people are changing and the general school environment is filled with all new obstacles and challenges. But what if, in addition to all of this, you found yourself absent-mindedly pulling out your own hair for seemingly no reason at all?

This was my reality when I entered sixth grade. Soon enough, I had huge patches of hair missing from my head, to say nothing of my eyelashes and eyebrows. As it turned out, this wasn’t some strange habit, but a neurobiological disorder called Trichotillomania.

Living With Body-Focused Repetitive Behaviors (BFRBs)

Trichotillomania is one type of Body-Focused Repetitive Behavior (BFRB) that involves pulling, picking or sometimes even eating body hair.  Other BFRBs follow the same pattern of behavior with different parts of the body. For example, skin picking or fingernail biting can be classified as BFRBs called dermatillomania and onychopagia, respectively, if they’ve done enough to cause physical or emotional damage.

A BFRB is not a bad habit; it’s a neurobiological disorder. Therefore, telling someone to “just stop” won’t help anyone. In fact, since pulling and picking can be exacerbated by stress, it might actually make the problem worse!  In addition to stress, many people pull, pick or bite when they are physically under-stimulated or bored. For example, many people who struggle with BFRBs unwittingly pick their skin or nails or pull their hair while reading or watching TV.

While there are some physical health risks that come with BFRBs (such as skin damage from picking too much and hair buildup in the stomach for those who eat their hair) the most prevalent negative consequence of living with a BFRB is the shame and isolation that often come with thinking you are alone in your struggle.

Despite the fact that at least one in every 20 people suffer from a BFRB, it remains relatively obscure compared to other (actually rarer) disorders such as schizophrenia. Many people go years, even decades, thinking they are the only one who struggles with these symptoms.

Luckily, there are many ways to help someone with a BFRB: support groups, fiddle toys, and behavioral therapy can all be great assets on the road to recovery. Behavioral therapy for Trichotillomania and other BFRBs usually focuses on identifying where an individual person is most likely to pick or pull and creating alternatives in that area.

These alternatives usually include items to keep one’s hands busy (doodling, or fiddling with a “fiddle toy”) or some sort of preventative barrier (bandages, rubber fingertips, or a hat). Many organizations, such as the Trichotillomania Learning Center (TLC), also offer workshops and conferences to help and offer support to people with BFRBs.

Many people who live with BFRBs find great relief in attending even one event because they are with people who truly understand their struggles and share coping skills. Shortly after my trichotillomania diagnosis, I attended a one-day workshop that made a huge difference for myself and for my family. This difference inspired me, as well as many others, to be open about BFRBs and raise awareness of trichotillomania.

It should be noted that BFRBs are distinct from intentional self-harm behaviors because they are not done with the intention of hurting the body or causing pain. They are also separate from compulsive behaviors that fall under the obsessive-compulsive spectrum, impulse control disorder (ICD) or things triggered by body dysmorphic disorder (BDD). 

These distinctions primarily have to do with the motivations behind the behaviors because people with BFRBs do not pick or pull with the intention of obtaining certain results – in fact, they are typically upset by the damage and try very hard to control or stop it.  These distinctions are important because the way BFRBs are treated differs from the way these others conditions are treated.

Although my BFRB began in middle school, BFRBs can start at any age. So, if you or someone you know picks, pulls or bites, know that there are millions of other people who live with this struggle. If you’ve been struggling with a BFRB, remember: you are not alone, it’s not your fault, and help is available.