Overcome compulsive nail biting, skin picking, and hair pulling

Lindsey M. Muller MS, LPCCI, Impulse Control Therapist L. Muller Therapy & Spectrum CBT

Whether you have started recently, or are a long-time sufferer, the behavior of skin picking, nail biting, or hair pulling is no less emotionally devastating or physically damaging. It can be confusing to sift through feelings and thoughts as you try to make sense of what your behavior means, why you do what you do, and how to make positive changes. Here are dos and don'ts for treatment for these body-focused repetitive behaviors.


Do find a knowledgeable treatment provider

Body-focused repetitive behaviors are very specific so it should not be much of a surprise that a psychology or therapy generalist would not be the best choice for treatment. The effective treatment for BFRBs is a specially designed treatment process that not all practitioners are aware of or feel comfortable in applying for their clients. Further, truly understanding these issues means understanding what questions to ask and what the possible associated thought processes are. Find a psychologist, therapist, counselor, or coach who specifically treats BFRBs using Acceptance and Commitment Therapy, Sensory Modality Evaluation, Behavioral Intervention, and Mindfulness (which is a component of ACT).

Do engage in physical activity

Physical activity has many benefits including increasing good feelings, increasing heart and brain functioning, strengthening the immune system, and aiding in mental clarity. Physical activity, as it specifically relates to picking or pulling, is an acceptable and appropriate behavioral alternative. It is not likely that you would pick or pull while walking, riding a bicycle, or playing tennis. Energy is being expended and various sensory modalities (touch, sound, sight, and smell) are being tapped into, similar to what happens when engaged in pulling or picking.

Do limit sugar intake

Many have found that high consumption of sugary foods strengthens urges. While there is not enough solid evidence to suggest that a diet alone causes anxiety, high levels of sugar in the bloodstream can mimic symptoms of anxiety such as feeling restless, on edge, fidgety, increased heart rate, and uneasiness. These somatic and emotional experiences can drive up BFRB urges. The best thing is to eliminate sugars all together to see how this personally affects your urges. If you believe you have an addiction to sugar, there is plenty of research out there to support the reality of such a nutritional struggle with an explanation of the negative effects of high levels of sugar consumption over time.

Do continue to do what creates happiness in your life

Although pulling or picking causes distraction from daily life, and uses physical, emotional, and mental energy, your life is more than this. Continue to remind yourself of who you are and what you enjoy. Find ways to engage in hobbies and activities that provide light-hearted fun and satisfaction, even if you have some hair missing. Do not lose sight of what is important in your life and remember that you are not defined by a label, a disorder, or a behavior. The current struggle is one part of a large picture- one tree in a forest of a lot of greenery.

Do find someone trustworthy to confide in (other than your therapist)

Aside from regular therapy, it is healthy and beneficial to have a close family member, friend, colleague, professor, or mentor whom you can entrust with your struggles. Self-disclosure provides an opportunity to reflect on our own thoughts and feelings, find acceptance, feel a sense of understanding, and lessen feelings of loneliness or isolation. Many who engage in picking or pulling have never met another individual who shares in this behavior; the experience can be very lonely. If not given the opportunity to meet and share with another who pulls or picks, the next best option is to find someone that will listen, care, empathize, and accept you for you.


Do not isolate

Picking and pulling often occurs in times of solitude rather than in front of others. Driving in the car, falling asleep at night, standing in front of the mirror, or standing in the bathroom are commonly reported environmental circumstances where these behaviors often take place. If you know that the key times when you pick or pull are when you are alone, then find ways to surround yourself with others. Isolation may seem like it is the easier choice when you have multiple blemishes on your face, missing eyebrows, or bald patches. Yet, withdrawing from social situations can jeopardize happiness and relationships. Further, isolation can lead to feelings of loneliness and sadness. Who would choose to feel that on top of skin or hair struggles?

Do not blame yourself

Picking and pulling affects so much more than just the way a person looks. Blaming yourself for your struggle can have a significant negative impact on self-esteem. Low self-esteem is a precursor for anxiety and depression. Further, blaming yourself can drive internalized self-hate which leaves very little room for self-love and growth of the self. In turn, these feelings, if left internalized and untreated, can worsen the pulling or picking behaviors. It becomes a vicious cycle.

Do not stop attending therapy if picking/pulling worsens

Therapy is a time when the emotional pot gets stirred. Old feelings and life experiences are brought to the forefront and reexamined in the context of the pulling or picking behavior. The behavior itself is also examined and re-examined. Mental energy is expended during the therapeutic process and new skills are being tested and practiced. Practice makes perfect. Practice does not mean perfection in accomplishing a therapeutic goal from the onset. The potential for strong urges to present themselves is very possible when working through the therapy process. Time heals so do not give up.

Do not become sleep deprived

Sometimes time spent engaging in precious, healthy sleep is exchanged for time spent pulling or picking. Not only will this lead to feelings of shame and guilt, but also sleep deprivation. When we are overly tired, our energy stores have been depleted. Therefore, we do not have the energy to ignore or fend off urges and employ therapeutically sound skills to keep from acting on these urges. With a sleepy brain, our guard comes down and we are more likely to give in and act upon urges as a way to self-soothe.

Do not think about the future in the context of your treatment

Thinking about the future, instead of focusing on the present moment, creates worry and anxiety which are counterproductive to helping yourself and the course of treatment. Instead, focus on today and break that down into smaller parts. Focus on this very minute. What can you do to minimize your chances of picking or pulling? Are you making healthy decision to help with urge reduction? Also, pulling today does not mean pulling forever. The struggle you are facing today may or may not be a struggle in the future. We cannot predict the future and we do not know what will happen. We only know what is happening right now, which is something within one’s reach and understanding. There is always the possibility of freedom from body-focused repetitive behaviors so it is best not to assume that the behavior will forever be in your life.

Jumping cartoon

As humans, we all have oddities, quirky behaviors, issues, and imperfections. All is not lost if you find that you engage in pulling or picking. There are scientifically valid treatment approaches and a life free of these behaviors is very possible. Remain positive as you take the necessary steps in evaluating your own life, learning, and implementing the necessary skills or tools to reduce urges and find freedom.

More expert advice about Obsessive-Compulsive Disorder

Photo Credits: diego cervo/bigstock.com; Check Man, Cross Man and Jump Man © ioannis kounadeas - Fotolia.com

Lindsey M. MullerMS, LPCCI, Impulse Control Therapist

Ms. Muller is a Licensed Professional Clinical Counselor Intern (#1687) practicing in Los Angeles. She has attended several universities across the country including Lehigh University, Auburn University, Valdosta State University, The University...

View Full ProfileRecent Articles