What it is
Hair pulling (sometimes called trichotillomania) and skin picking (sometimes called excoriation) are part of a group known as body-focused repetitive behaviors, or BFRBs. They involve recurring urges to pull, pick, or pinch at the body, often in ways that feel hard to stop even when someone wants to.
These behaviors can happen automatically, almost without noticing, or they can be more focused, happening during moments of stress, boredom, concentration, or strong emotion. Many people describe a buildup of tension beforehand and a sense of relief or release afterward.
BFRBs are common and understandable human experiences, not a sign of weakness or a lack of willpower. People of all ages and backgrounds experience them, and feelings of shame or secrecy are common but not necessary.
How it’s traditionally been approached
In the past, hair pulling and skin picking were often misunderstood as simple habits or something a person could stop just by trying harder. This view frequently left people feeling blamed rather than supported.
Over time, these behaviors came to be recognized as body-focused repetitive behaviors, patterns shaped by emotion, attention, environment, and the body's stress response. This shift helped move the conversation away from willpower and toward understanding.
Today, many people explore BFRBs with a trained professional who can help them notice patterns and triggers. Awareness-based and behavioral approaches are among the methods therapists often draw on, always tailored to the individual.
How a therapist may help
A therapist who uses cognitive and behavioral approaches may help you become more aware of when and why urges show up, including the thoughts, feelings, and situations that tend to surround them. Building this kind of awareness is often where the work begins.
Sessions generally involve exploring your personal patterns, gently examining the beliefs and emotions tied to the behavior, and discussing ways to respond differently to urges. Therapists who specialize in BFRBs and habits often use these cognitive-behavioral methods, and some may draw on habit-focused strategies, as a collaborative, supportive process rather than a one-size-fits-all plan.
Many people find that this kind of work can lead to fewer urges and a greater sense of control over time. Progress tends to be gradual, and a therapist can help you set realistic, compassionate expectations along the way.
Where mind meets body
Hair pulling and skin picking sit right where the mind and body meet. Thoughts, emotions, and the body's stress response constantly influence one another, which is why an urge can rise with tension and ease with a physical motion. Understanding this connection can make the behavior feel less mysterious.
Because of this mind-body link, some people pair thinking-based therapy with body-based (somatic) practices for a more whole-person approach, especially when stress or tension plays a role. To learn more about body-based options, you can explore Somatic Experiences, our sister site focused on somatic approaches.
Explore on Somatic Experiences: nervous system regulation →Explore on Somatic Experiences: highly sensitive →
Keep in mind
- A licensed professional should guide care, especially if skin picking or hair pulling leads to physical harm, infection, or significant distress.
- Coaching, groups, and self-help resources can offer support and connection, but they are not a treatment for any condition.
- Any decisions about medication are made with a licensed prescriber.
- If you are in crisis or thinking about self-harm, you can call or text 988 or call 911 in the US.
Therapists who often help
Get matched privatelyFrequently asked questions
What are hair pulling and skin picking?
Hair pulling and skin picking are body-focused repetitive behaviors, or BFRBs, that involve recurring urges to pull hair or pick at skin. They often feel hard to stop even when a person wants to. These behaviors are common and are not a sign of weakness or lack of willpower.
Can therapy help with hair pulling and skin picking?
Many people find that working with a therapist may help them gain more awareness of their urges and a greater sense of control over time. Therapists who specialize in BFRBs often use cognitive and behavioral approaches. Results vary from person to person, and progress is usually gradual.
Why do I pull my hair or pick my skin?
These behaviors are often tied to emotions, stress, boredom, or concentration, and the body's stress response can play a role. Some people pull or pick automatically, while others do so more intentionally in response to tension. A therapist can help you explore your own personal patterns and triggers.
What kind of therapist helps with BFRBs?
BFRB and habit specialists often help with hair pulling and skin picking, frequently drawing on cognitive-behavioral and habit-focused approaches. These professionals can work with you to understand your patterns in a supportive, collaborative way. Choosing a therapist experienced with BFRBs can be a helpful starting point.
Is medication used for hair pulling or skin picking?
Any decisions about medication are made with a licensed prescriber who can discuss what may be appropriate for you. This site does not offer medical advice. Therapy and a prescriber's guidance can sometimes be part of a broader, individualized approach.
Can body-based practices help with skin picking or hair pulling?
Because stress and tension often involve the body, some people pair thinking-based therapy with body-based (somatic) practices for a more whole-person approach. The mind and body influence each other, which is why both can be worth exploring. You can learn more about somatic options at Somatic Experiences.
Educational resource. Therapists.plus shares general information and connects people with independent therapists, coaches and groups. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health. In a crisis in the US, call or text 988 or call 911.
