CBT | Skin Picking, Nail Biting Treatment

A 28-year-old architect has had trichotillomania and dermatillomania since she was a pre-teen. She would spend approximately 40 minutes per day engaged in these body focused repetitive behaviors and was often late to work because of it. She reported having tried very hard to stop these rituals on her own by setting time limits, delaying urges, using acrylic nails, not wearing clothes that reveal her skin, $1500 on electrolysis to cut down on compulsive tweezing, shutting off bathroom lights, etc. However, she has not been able to gain enough control over her urges to have any sustained improvement. After the first week of treatment, she reported a 30 to 40% reduction in skin picking and hair picking. By the fourth session, she had a 70% reduction in her behaviors. As her confidence grew, she felt ready to conquer a weight loss goal and lost 10 pounds in 12 weeks. During her time in treatment, she had several work-related and personal stressors that would ordinarily set her progress back. However, she continued to control her urges to pick and overeat. By session 6, she was 90% improved. She even had a break out of acne and was able to leave her blemishes alone. By session 9, she reported 99% improvement.

A 30-year-old attorney came to us after struggling with a chronic nail biting habit since she was 3 years old. She reported that it was a self-soothing strategy during tantrums. She tried bitter tasting polishes and tried to will herself to stop but to no avail. The damage was extensive, leaving her with completely exposed nail beds and no nails on any of her fingers. She feared they wouldn’t grow back at all. On sessions 2 and 4, she reported no biting at all those weeks and was feeling very optimistic about her success. By week 7, she felt 90% improved, having been free of nail biting for the last few weeks. By the 8th session, she planned to have her first manicure she has ever had. She graduated treatment with ten well manicured nails.

A 25 year old pre-school teacher had struggled with compulsive skin picking and nail biting for several years. Her behaviors caused significant turbulence in her relationship with her boyfriend because he did not support her going to therapy and felt she should be able to stop these behaviors on her own. She presented with severely scarred skin and had frequent break outs because she constantly touched her face. We were able to track how, when, where and why she picked and she quickly learned how to use habit reversal techniques to gain awareness, control her urge, and sit with the discomfort of the imperfections on her nails and skin. By the 8th session she reported 85% improvement in her skin picking. Within a few months time, she was able to fully eradicate her body focused repetitive behaviors.

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