Trichotillomania (Hair Pulling) and Excoriation (Skin Picking)

Trichotillomania (hair pulling disorder) and Excoriation Disorder (skin picking disorder) are body-focused repetitive behaviours (BFRBs) that involve recurrent pulling, picking, or grooming behaviours that are difficult to control.

These behaviours are not simply “bad habits.” They are often automatic, tension-reducing responses that serve a regulating function for the nervous system.

Common Experiences

Individuals experiencing BFRBs often report:

  • A build-up of tension or urge before engaging in the behaviour

  • Temporary relief or satisfaction afterwards

  • Difficulty stopping once started

  • Repeated attempts to reduce or stop the behaviour

  • Feelings of shame, guilt, or self-criticism

How Therapy Can Help

Habit Reversal Training (HRT) is considered the gold standard treatment and focuses on:

  • Increasing awareness of triggers and early warning signs

  • Developing competing responses (physically incompatible behaviours)

  • Modifying environmental triggers (stimulus control)

  • Building alternative coping strategies

Treatment may also incorporate Cognitive Behavioural Therapy (CBT) to address unhelpful thoughts, perfectionistic tendencies, and emotional regulation patterns.

Therapy is collaborative and paced according to individual needs, with an emphasis on reducing shame and building self-efficacy.

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