Hair Pulling and Skin Picking: Why Willpower Isn’t Enough to Stop

Written by Julie DiMatteo, Ph.D., ABPP

You may tell yourself it’s the last time. Then, without meaning to, you find yourself pulling your hair or picking your skin again.

If you continually pick your skin, hair, or nails, you might feel frustrated with yourself, wondering why you can’t stop even when you’re causing yourself pain, bald spots, or scars.

If this sounds familiar, willpower is not the issue. It’s not simply a matter of having more self-control. Hair pulling and skin picking are real mental health conditions. They are also treatable with the right kind of support. Let’s talk about it.

When a Habit Is Really a Mental Health Condition

Hair pulling and skin picking belong to a group of conditions called body-focused repetitive behaviors (BFRBs). BFRBs are more than just a habit; they are a group of mental health disorders that require the same attention and care as any other condition.

Trichotillomania is the medical name for repeated hair pulling, where someone may pull hair from their scalp, eyebrows, eyelashes, or other areas of the body. Dermatillomania is the name for repeated skin picking, which can involve picking at acne, scabs, bumps, dry skin, or areas that feel uneven.

BFRBs aren’t just limited to hair or skin, however. It can include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails. These behaviors may happen on purpose or without much thought. 

Why Can’t I Just Stop Pulling My Hair Or Picking My Skin?

If you have tried to stop pulling your hair or picking your skin, you may feel frustrated, embarrassed, or ashamed when it happens again. You might believe that you need more self-control or should be able to stop on your own.

But struggling with a body-focused repetitive behavior does not mean you are weak or doing something wrong. BFRBs are recognized mental health conditions. They are more complicated than bad habits, and willpower alone is often not enough to overcome them.

Pulling or picking typically meets a need in the moment, like relief from stress or boredom. The relief may only last a few seconds, but it can teach your brain to repeat the behavior.

Over time, the movements can also become automatic. Your hand may move toward your hair or skin before you are fully aware of what is happening. This can create a difficult cycle:

• You notice an urge, feeling, texture, or situation that triggers the behavior.

• You pull or pick.

• You briefly experience relief or satisfaction.

• You later feel regret, shame, or physical discomfort.

• You promise yourself that you will stop.

• Another trigger starts the cycle again.

This cycle is not your fault. Your brain learned to repeat a behavior that provided something it needed, even if the relief was brief. 

With the right support, you can learn what triggers your behavior and find healthier ways to meet those needs. A BRFB therapist can help you approach the problem with greater understanding, useful tools, and other support.

How Can a BFRB Therapist Help?

A therapist who understands BFRBs will work with you to understand your particular pattern.

Treatment may start by tracking when and where the behavior happens. You might explore what you were doing, thinking, and feeling at the time. Your therapist may also ask about physical sensations, such as itching, rough skin, or certain hairs that catch your attention.

Then, a BFRB-trained therapist will help you identify the different factors that cause you to pull your hair or pick your skin. Next, you’ll find strategies that fit your specific triggers. For instance, you might find safer ways to meet a sensory need or change your environment to make the behavior harder to perform.

 The goal is not to punish yourself or keep your hands busy every minute. It is to build skills that work in the situations where you need them most.

Specialized Help For Skin Picking & Hair Pulling In NJ, NY & CA

With treatment, you can learn to understand your triggers instead of blaming yourself. You can also develop practical tools to overcome your habits and feel more in control of your choices.

CBT Specialists provides specialized treatment for hair pulling, skin picking, and other BFRBs. We offer in-person therapy in Rochelle Park, NJ, and Ventura, CA, as well as online therapy throughout the country. Reach out today to learn whether BFRB therapy could be the right next step for you.