More Than Just a Bad Habit

By Tasneem Abrahams –

We’ve all used the expression “pulling my hair out” when referring to feelings of frustration or anxiety. But for some, this is more than just an expression when the act of pulling ones bodily hairs in response to overwhelming emotions becomes a very harsh, often debilitating reality.

Compulsive hair pulling, nail biting and skin picking are some of the behaviors you may recognize as simply common bad habits most people have engaged in at one time or another. However for some these can develop into a serious condition known under the umbrella term as Body Focused Repetitive Behaviors or BFRBs.

These disorders are characterized by compulsive direct body-to-body motor actions, which results in physical damage, but also negatively impacts the individual’s functioning in one or more areas of daily living. For example, the compulsion to pick at the skin often takes large amounts of time resulting in the individual being late often or decreasing their efficiency at work.

The visible damage such as skin scarring or noticeable hair loss can also lead to the person either avoiding social situations where the affected areas will be seen, or dressing inappropriately to the weather in an attempt to hide the ‘evidence’. For instance many skin pickers report that they avoid going to the beach or public swimming facilities and always wear long sleeves and long pants so as not to display the scars on their legs or arms.

What causes BFRBs?

There is no single cause for the development of BFRBs, but one of the many links found is the experience of overwhelming stress or negative emotions such as anxiety, anger or sadness. But it can also be a sensory seeking behavior in response to under-stimulation, for example during times of boredom or inactivity. These undesirable behaviors tend to develop when we do not acquire the ability to self-regulate negative emotions and experiences in healthy ways. The sensation of pulling ones hair or biting ones nails can be experienced as tension relieving, soothing or even pleasurable, resulting in the individual seeking out this feeling again.

Avoiding the cycle

Habits do not form overnight. It takes time, repetition and positive feedback for a bad habit to form. The greater the reward experienced by engaging in the habit, the more likely a compulsive disorder will begin to emerge. For example nail biting is often synonymous with nervousness and worry. The person may find that biting the nails provides a tactile distraction from negative thoughts and soothes the anxious mind.

The person then seeks out to experience this soothing distraction the next time they feel worried or nervous. A cycle occurs which is not unlike addiction, whereby the greater the expectation of the positive feeling, the greater the urge to engage in the behavior becomes. This then results in the person becoming dependent on nail biting to process and deal with feelings of nervousness or anxiety. This cycle can sometimes occur unnoticed so that the person is not even aware of the urge to bite their nails and so the behavior becomes automatic.

Breaking the Cycle

The key to breaking the cycle of behavioral dependency is to address the underlying nervousness and to attain relief from anxiety via more acceptable or productive behaviors. However sometimes we are not necessarily aware that we are feeling anxious so developing an awareness of what we are thinking or feeling is essential. Cognitive Behavioral Therapy has been found to be the most effective modality in the treatment if BFRBs and one of the skills taught is the practice of mindfulness. Mindfulness is about actively ‘listening’ to our inner selves and acknowledging what we are feeling at any given time. Once you are aware of feelings of anxiety you can then consciously choose to respond to these emotions in a more desirable way such as deep breathing, talking to a friend, or exercise. It differs for everyone so it important that you find the strategy that works best for you. It is human nature to try to avoid that which is unpleasant, but it is only through acknowledgement of our negative emotions that we are able to move past them in healthy and effective ways.

Tasneem is an experienced CBT therapist, and she’s part of the trichstop.com online therapy program, treating people with trichotillomania online.