The main BFRBs are trichotillomania (hair-pulling)…excoriation (skin-­picking)…and onychophagia (nail-­biting). Sufferers can spend hours each day pulling, picking or biting. The habits can cause a variety of health problems from skin infections to depression, anxiety and isolation.   

BFRBs are a challenge to treat—no single treatment works for everyone. But there are therapies that help…

Forms of cognitive behavioral therapy (CBT) work best. CBT attempts to change behavior and associated thoughts. A specialized form of CBT, known as habit reversal, has the strongest support for success in treating BFRBs. Here, with the help of a therapist, patients learn to recognize feelings, such as boredom or stress, and situations that trigger the urge to pull, pick or bite. They then develop strategies, like clenching their fists, that make the unwanted behavior impossible. 

Habit reversal is well-suited to those who engage in BFRBs without thinking. It helps patients to be more aware of the problem in time to prevent it. Other patients, however, engage in BFRBs with full awareness, possibly because they believe the behavior will alleviate anxiety or boredom. And some patients are aware of what they’re doing at times and unaware at other times. In these instances, other CBT interventions may be needed to supplement habit reversal. These could include acceptance and commitment therapy, which encourages patients to tolerate the urges to pull, pick or bite, without acting on them. Meditation and relaxation exercises are also helpful.

Mental health professionals specifically trained to treat BFRBs may be difficult to find. For a directory, go to BFRB.org, click on “Find Help + Support,” then on “Find a Therapist.” 

Several sites offer programs to supplement therapy. Try StopPulling.com or StopPicking.com. 

Medications are generally prescribed in combination with psychotherapy to lessen the feelings that lead to BFRBs. Medications for BFRBs include the same selective serotonin reuptake inhib­itors (SSRIs) given for depression, anxiety and obsessive-compulsive disorder (OCD). Mood stabilizers can be effective for some individuals.

N-acetylcysteine (NAC), an amino acid supplement, helped more than half of those with trichotillomania, a recent study found. NAC may help those with skin-picking and nail-
biting, too. Note: Check your doctor before starting NAC for instructions on dosage and how to take it. 

Self-help strategies from BFRB sufferers and mental health professionals…

• Play with fidget toys, such as a fidget spinner, to keep hands occupied.

• Wear white cotton gloves to ­prevent skin-picking and nail-biting. 

• Handle a piece of velvet as a substitute for picking or pulling.

• Pop Bubble Wrap as a substitute for skin-picking.

• Wear a bandanna or hoodie to bed to prevent hair pulling overnight.

• Pull the bristles out of an inexpensive paintbrush to keep hands busy. 

For more self-help tips: At BFRB.org, click on “Treatment” under “Learn,” then on “Self-help tools.” 

New research: The BFRB Precision Medicine Initiative is gathering detailed information from more than 300 people with BFRBs in order to gain clues for better treatment. Also, a clinical trial is currently under way to test the effectiveness of the Comprehensive Model for Behavioral Treatment (ComB) for hair-pulling, a CBT approach that aims to identify the function of the behavior and create a replacement for it. Treatments include a scalp massager, deep breathing and wearing bandages on fingertips.