Skin Picking (Excoriation Disorder) and Hair Pulling (Trichotillomania) are mental health conditions classified under body-focused repetitive behaviors (BFRBs).

Trichotillomania involves the uncontrollable urge to pull out one’s hair, often resulting in noticeable hair loss, while Excoriation Disorder, also known as skin picking disorder, involves repetitive picking at the skin, which can cause tissue damage.

Both behaviors are often used as coping mechanisms to manage stress, boredom, or anxiety but can lead to significant emotional distress and physical harm.

Key points about Trichotillomania and Excoriation Disorder:

• Trichotillomania (Hair-Pulling Disorder): Involves repeated pulling out of one’s hair from the scalp, eyebrows, eyelashes, or other body areas, often causing visible hair loss and attempts to resist the urge.

• Excoriation Disorder (Skin Picking Disorder): Characterized by the repeated picking at skin, often on the face, arms, or hands, which may lead to scarring, infections, and significant skin damage.

• Compulsive Nature: Both disorders are marked by repetitive behaviors that are challenging to control and are often performed to relieve tension or emotional discomfort.

• Emotional Impact: Individuals with these disorders may experience feelings of shame, embarrassment, or frustration, leading them to avoid social situations or hide the physical signs of their behavior.

Treatment Options for Trichotillomania and Excoriation

Comprehensive Behavioral (ComB) therapy is an evidence-based treatment designed for individuals with Body-Focused Repetitive Behaviors (BFRBs) like skin picking (excoriation disorder) and hair pulling (trichotillomania). Developed by Drs. Charles Mansueto, Ruth Golomb, and other experts, ComB therapy takes a holistic and individualized approach to address the unique triggers and maintaining factors for each person's behavior. Here's how it works:

Core Components of ComB Therapy:

1. Assessment of Triggers and Maintenance Factors:
   The therapist helps identify internal and external triggers, such as emotional states (e.g., stress, boredom), environmental cues, or sensory experiences. This includes understanding when, where, and why the behaviors occur.

2. Functional Analysis:
   Behaviors are analyzed through five "modalities" to uncover their function for the individual:

Contact Julie at Reframe CBT to learn ComB can help you or your loved one with skin picking or hair pulling.