Understanding body-focused repetitive behaviors in your child

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

We all have family but not all of us have family members that are supportive or even know about managing a body-focused repetitive behaviors (BFRBs) such as skin picking or hair pulling (called Trichotillomania). These are diagnosed mental health issues that can be confusing and painful to watch as an outsider. BFRBs affect up to five percent of the population at one point in his or her life but are not readily discussed by the individual who is struggling. How do you deal with family members that just don't get it? "My relatives just found out I pick my skin [bite nails, pull hair]. They are mad at me, frustrated, and are telling me to 'just stop'". Coming from the parents, “My teen is pulling out his hair and he knows it frustrates me. Is he trying to get back at me?” Here are some guidelines for parents.


Do educate yourself

I cannot emphasize this enough. When you feel you can grasp the concepts associated with a situation, it may help with acceptance and willingness to help. If you do not understand what BFRBs are let alone the associated thoughts, feelings, and urges, there may be frustration or some other emotions. Understandably so. Yet, anger, frustration, and self-blame are counter-productive emotions in this situation as they cloud ones thought from finding the solution or finding answers. Once you learn the who, what, when, where, why and how of BFRBs, it will be at this time that you can recognize that it is possible to interact with a child, teen, or adult child with a BFRB in a supportive, loving, healthy way. It will also provide clarity as to where to seek treatment, if desired.

Do show support, love, and care

If your son or daughter is struggling, one of the best presences by a parent is one of strength, love, and encouragement even with things are not going so well. It is also important for your son or daughter to see that your love is not determined by how well they are doing with the recovery process.

Do ask questions to a knowledgeable individual

Find a credentialed (licensed) mental health practitioner and ask questions such as:

  • The different treatment approaches available. Which have been determined to be the most effective in treating the behavior at hand?
  • The average start of the disorder.
  • The topic of medication. Does it work for treating dermatillomania or trichotillomania?
  • The different types of therapy such as Cognitive Behavioral Therapy, Behavioral Therapy, Psychoanalytic Therapy, Existential Therapy. What do these names mean and how does it work with or against treating BFRBs?

This is a good starting place. As you are finding answers to these questions, also question the source of your information. Who is this person sending out this information to the web? Does he or she have the credentials or education to be answering such questions?

Do allow for setbacks

Entering into therapy does not mean that everything will be uphill from thereafter. Part of understanding this disorder, and many others, is knowing that setbacks will happen. Allow for there to be imperfections in the recovery process to keep from extreme surprises and let-downs. Slip-ups are so common that even the best therapists expect for them to happen from time to time.

Do focus on your other loved ones as much as your son or daughter diagnosed with a BFRB

A behavior, such as skin picking or hair pulling, is one part of many things that you as a parent have to focus on. Do be attentive to how much focus is being placed on a diagnosis versus your other children, accomplishments, victories, and other major life event. Taking care of yourself and maintaining healthy boundaries by having your own life will keep you happy and healthy. In turn, this will maintain a healthy relationship with all other family members and a healthy family unit as a whole.


Do not ask why

Why cannot always be answered, so refrain from asking "Why do you pull/pick"? This is a question that is better left to be asked by a therapist or psychologist. This is where therapy or counseling enter the picture. The purpose of participating in therapy is to uncover what is underlying the behavior and answer the 'why' question. This may take a considerable amount of time-weeks, months, years- to truly peel back the layers.

Do not try to play the role of therapist, doctor, psychologist, or psychiatrist

With a plethora of knowledge at our fingertips (thanks to Google and other popular search engines), it is very attractive and enticing to get on the computer and start searching for treatment techniques and diagnose family members. While I fully support educating, researching, and reading (as aforementioned), it would be in the best interest of the individual if you did not circle back around with a list of actions or changes he or she "needs" to make. You will be greeted with resistance, hesitancy, or anger which will only serve as a hinderance to your relationship and the family unit.

Do not tell your son/daughter/loved one to “just stop” the behavior

"Just stop" will lead to your son/daughter feeling like you don't get him or her, and that you are in the opposing position of working together as a support system. From here, he or she will likely back away, retreat, or simply refrain from telling you anything as it relates to the situation. Conversely, the best type of relationship is a strong, secure, safe line of communication where your child or teen can let you know whether it was a "good day" or "not so great day" and you are there to listen, comfort, and support regardless of the day's outcome. If it was as easy at just stopping, the term BFRB would not exist. And if your family member, with all the suffering, energy, and time spent engaging in and concealing the behavior truly wanted to stop and had that as a readily-available option, he or she would have done that yesterday.

Do not blame

It is not your fault. It is not your son’s/daughter’s fault. This behavior is present for biological reasons, or as a warning that there is an underlying emotional issue to be addressed. Blame never makes anyone feel better, nor does it reduce the situation.

Do not try to motivate

Motivation is something that comes from within. Although you may think it is the perfect time to stop the behavior or to begin therapy, your son or daughter may not. True recovery comes from the person who is struggling making the decision for himself or herself to stop. Lectures, punishment, shame, guilt, blame… this is just negative energy waiting to pass by.

Jumping cartoon

When a diagnosed BFRB enters into the family unit, parents often feel more resistant and afraid of making a mistake and saying the wrong thing than continuing to be a great parent. Underlying all situations, no matter how big or small and no matter whether they are mental health related or not, is the desire to have a strong, supportive, loving, caring, and nonjudgmental support system. Let this be your guide. Move forward with hope that each day is a new opportunity to be “behavior free”. Feel hopeful and excitement at the prospect of helping your son or daughter get closer to recovery. Lastly, parenting is challenging enough. If you need help and are able to get help, do it!

More expert advice about Obsessive-Compulsive Disorder

Photo Credits: andres/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...

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