Hypnotherapy for Body Focused Repetitive Behaviours (BFRBs) like hair pulling (trichotillomania), skin picking (dermatillomania), nail biting (onychophagia)

Is your pulling, picking or biting resulting in permanent damage to your hair, skin or nails? Perhaps you have a sense that you must remove imperfections to create smooth, blemish-free perfection? Have you tried all sorts of things to stop, but not been able to? Does your pulling, picking or biting take up a lot of time and energy? Are you doing your hair, or wearing clothes and make up with the specific goal of covering up bald patches, regrowth, scars, infections or scabs? Do you feel like you're the only one with this unwanted behaviour that you have to keep secret?

We specialise in hypnotherapy for Body Focused Repetitive Behaviours (BFRBs) like hair pulling (trichotillomania), skin picking (dermatillomania), nail biting (onychophagia) and thumb sucking, as well as less well known behaviours like lip biting, cheek biting, nose picking and eating hair or skin. Sian is a Professional Member of The TLC Foundation for Body Focused Repetitive Behaviours, and has completed their professional training for treatment of BFRBs. For more about how hypnotherapy can help you change specific BFRBs, see the links below:

• hair pulling (trichotillomania)
• skin picking (dermatillomania)
• nail biting (onychophagia)

What are Body Focused Repetitive Behaviours (BFRBs)?

Body Focused Repetitive Behaviours (BFRBs) are a set of behaviours on the Obsessive Compulsive spectrum, involving difficulties with impulse control and characteristics like perfectionism, self-criticism and being easily bored or frustrated. Typically, people with BFRBs will regularly engage in repetitive self-grooming habits that damage their bodies, for example, pulling, picking, biting or scraping of the hair, skin or nails. It is crucial to note that BFRBs are about fixing, changing or otherwise sorting out perceived flaws, and that any damage is an unintended consequence of this activity.

In addition to the physical impact of Body Focused Repetitive Behaviours (BFRBs), people often also experience a sense of shame and isolation, frustration, anxiety and low self-esteem related to the behaviour and its impacts. This often creates a vicious cycle, as the consequences of the BFRB has a negative effect on relationships, work and overall quality of life, which often leads to more of the unwanted behaviour to alleviate the uncomfortable feelings being experienced.

While there are instances of people who have started experiencing a BFRB much earlier than adolescence, most people start between the ages of 11 and 13. Over time, BFRB's often feature cycles of varying severity.

Symptoms of Body Focused Repetitive Behaviours (BFRBs)

BFRBs such as pulling, picking or biting often occur when a person is awake, but unaware or focussed on something else; for example, when watching TV, reading, using a computer or phone, getting ready to go to sleep. Often the experience of doing the behaviour (picking, pulling, biting) is pleasurable or satisfying as a person does it, making it more challenging to change the habit. In addition, many people also engage in highly focused sessions of pulling, picking or biting that can last several hours, though often there is little awareness of time passing. BFRBs can also happen when a person is asleep.

Body focused repetitive behaviours tend to follow the classic negative behaviour cycle. The urge to pull, pick or bite arises, caused by a trigger (obvious/not, internal/external). The trigger can be active (eg grooming behaviour such as scanning for imperfections) or just a sensation that occurs. Then there is the person's response, which often involves attempts at resistance, followed by giving in and pulling, picking or biting until reaching a point of satiation.

Afterwards, there is a strong awareness of the damage done, along with feelings of failure, shame, self-criticism, anxiety and being out of control, and resolution to not pick again. These negative reactions often lead to uncomfortable feelings, which triggers more of the unwanted behaviour.

You may experience all or some of the following symptoms as part of a BFRB:

• Sense that hair, skin and nails must be smooth, perfectly blemish-free, along with a high sensitivity to any perceived imperfections
• Strong urge to pull, pick, bite your hair, skin or nails (with hands or implements), often to the point of pain and/or bleeding
• Difficulty resisting the urge to pull, pick or bite; the response to the urge seems automatic and irresistable
• Bald patches, fine regrowth/no regrowth; scabs, scars, tissue damage, infections
• Repetitive strain injuries or joint damage from regularly holding pulling, picking or biting positions for long periods
• A lot of time and effort spent on pulling, picking or biting activity, routines and its consequences
• Concealing the impact of pulling, picking or biting, for example lying about causes of marks; using make up, clothing and accessories to cover up, and avoidance of situations where bald patches, skin, hands may be exposed
• Feelings of being out of control, weak, frustrated, uncomfortable in your own skin, body dysmorphia
• Low self-esteem, anxiety, isolation, depression, which have an ongoing negative affect on your work, relationships and health

Causes of Body Focused Repetitive Behaviours (BFRBs)

Currently there is no clear understanding of what causes BFRBs. The following are likely to be causal factors, though no single cause has yet been established: genetic predisposition, disruption of common grooming behaviours, certain character traits and environmental factors (stressful events). It seems reasonable to assume that BFRBs tend to be the result of a combination of these variables at any given time.

BFRBs often appear to run in families, which means there may be a genetic predisposition to them. However, there is not yet any conclusive research to indicate that this is the case. It is also worth noting that even if there is no genetic basis to a behaviour, early exposure to important figures having these responses can contribute to an individual modelling their own behaviour after this example eg "all the women in my family pick their skin", "my dad and my grandad also bite their nails".

Another possible cause may be that BFRBs are the result of disruption to the natural grooming behaviours common in most living beings. It has been established that animals in stressful situations can develop similar behaviours eg licking skin too much resulting in scabs, or eating their own fur. Further research is necessary to understand these similarities and how they can further understanding of the conditions and treatment approaches.

Research conducted at the University of Montreal in March 2015 indicates that some character traits may predispose individuals to developing a BFRB. These include being easily frustrated and impatient, and high levels of perfectionism.

Environmental factors (stressful events) are often clear triggers for an increase in BFRBs, though it is not clear whether they can function as a single cause that initiates the behaviour. Stress tends to reduce our ability to be in control and increases our focus on short term relief from the unpleasant impacts on mind and body. This can make it challenging to tolerate the discomfort of an urge to pull, pick or bite, or to stop a pulling, picking, biting cycle before it gets worse.

Stress and anxiety often also create a focus on the negative, so self-esteem and confidence can drop, alongside an increase in withdrawal and social isolation. Strategies to manage stress and anxiety on physical, emotional and mental levels are generally very effective for BFRBs, both in the moment and over the long term.

How hypnotherapy can help Body Focused Repetitive Behaviours (BFRBs)

Hypnotherapy is very effective for BFRBs, as it helps you to address what is a very complex issue on several different levels. Firstly, hypnotherapy can help you to be more aware of your hands, so you can be more in control. It allows you to develop a more beneficial response to the urge to pull, pick or bite, for example by creating a competing response that is incompatible with the behaviour, and by building up your ability to "stop at one". It also gives you relief from physical symptoms, and helps to resolve the psychological impacts of your pulling, picking or biting. The hypnotic trance is also good for deep relaxation, so your stress and anxiety levels are reduced, which in turn makes it less likely that you'll want to pull, pick or bite.

In the deeply relaxed and focused state of hypnosis, your subconscious is more receptive to revising thoughts and actions, so you can start to change the habit, replacing pulling, picking or biting with a new, positive action. You can also rehearse using the positive, new habit in a range of situations, seeing, feeling and sensing how you can be comfortable and confident without pulling, picking or biting. And if for any reason you do pull, pick or bite, hypnotherapy can help you to "stop at one", so you get back in control more easily and readily.

In addition, if an experience/s from the past is contributing to your BFRB, the hypnotic state allows you to safely and easily work with this experience, so it no longer creates the urge to pull, pick or bite. Hypnotherapy can also help you develop the determination, confidence and patience to go through the challenges associated with the process of letting your hair, skin and nails heal, such as letting new hair grow in, leaving scabs or cuticles to heal in their own time, being able to "stop at one", and beginning to feel more comfortable with letting light and air onto your hair, skin and nails.

For more information about hypnotherapy for Body Focused Repeptitive Behaviours (BFRBs) like hair pulling, skin picking, nail biting or thumb sucking, or to book an appointment, contact Sian on 07725 732810 or email.

...I can honestly say my sessions with Sian have changed my life. I have not rubbed my eyebrow at all since my first session (it has now grown back) and we progressed to addressing other habits, particularly picking my skin...
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...when I booked my first hypnotherapy session I was sceptical that I could break many years of habit in just a few sessions, as other forms of therapy had failed before. Sian seemed to really listen and understand my concerns. I was able to benefit very quickly from our sessions which addressed my hair pulling and nail biting habits by providing practical solutions. I feel a lot more hopeful about the future...
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Absolutely delighted with the results. After 29 years of compulsive nail biting I think Sian has helped me crack it in three sessions over six weeks...
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...since the session, I've noticed a really dramatic change, especially with the tendency to pick & scratch my arms when I get anxious or nervous. It's like my hands just don't want to do it any more, instead they just glide over. It's a really amazing change!...
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...I found the sessions very useful, as I'm much more relaxed now and pulling my hair less and less. I was very nervous beforehand, but you put me at ease straight away. I have to say I was pleasantly surprised at the results: I feel more in control, my scalp is looking much better, and I even have some new hair growing back!...
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...I cannot thank Sian enough for helping me overcome my fear of speaking French. This resulted in me being able to enjoy a great holiday, unmarred by any major worry about speaking the language when required. I never thought that would be possible!...
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...since our last session over 5 weeks ago, I have carried on with the success from the first session, with only 2 nights of disturbed sleep in this period. This is an unbelievable change from sleep walking and talking every night for almost 20 years!...
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...I have to say that my recent therapy achieved far more than my expectations. After only three sessions, I have managed to put some very negative past experiences behind me, and I can already see huge positive changes in my outlook and ability to cope with anxiety and stressful situations...
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