Understanding Why You Can’t Stop Pulling Your Hair or Picking Your Skin
Many people with trichotillomania (hair pulling disorder), dermatillomania (skin picking disorder), and other body-focused repetitive behaviors (BFRBs) describe the same painful experience:
“I know I am doing it, but I feel unable to stop.”
They may notice bald spots, missing eyelashes or eyebrows, thinning hair, scabs, scars, or ongoing skin damage caused by behaviors they desperately want to control.
Many have tried to stop through willpower alone, making promises to themselves, hiding the damage, or feeling intense shame after realizing what happened. Yet the behavior continues.
This can leave people feeling frustrated, embarrassed, and misunderstood.
BFRBs are not simply “bad habits.” They are complex behaviors involving interactions between sensory experiences, attention, emotional regulation, learned habit patterns, and the brain’s reward system.
Understanding why these behaviors happen is the first step toward changing them.
Frequently Asked Questions About Trichotillomania, Dermatillomania, and Body-Focused Repetitive Behaviors
Why can’t I stop pulling my hair or picking my skin even though I want to stop?
One of the most frustrating aspects of BFRBs is that people often have full awareness that the behavior is causing harm, yet still feel unable to interrupt it.
This is because BFRBs are not simply conscious choices or “bad habits”. Over time, the brain can learn that pulling, picking, or repetitive grooming provides temporary relief, satisfaction, stimulation, or sensory regulation.
The behavior becomes part of a powerful habit loop:
- A trigger occurs (stress, boredom, concentration, a certain sensation, or noticing an imperfection).
- An urge develops.
- The behavior provides temporary relief or reward.
- The brain learns to repeat the pattern.
This is why many people describe feeling as though they are acting on autopilot. They may notice their hand is already touching their hair or skin while watching television, working, reading, or using their phone. Others may intentionally search for a specific sensation, hair, texture, bump, or imperfection that feels “wrong” and needs to be corrected.
These patterns are known as automatic pulling/picking and focused pulling/picking, and many individuals experience a combination of both.
The problem is not a lack of motivation. The brain has learned a pattern that needs to be retrained.
Why do I pull out my eyelashes or eyebrows even though I know I will regret it?
Many individuals with BFRBs experience intense shame after the behavior. They may think, “Why did I do this again?” or “I should be able to control this.”
However, shame often keeps people stuck in the cycle. Effective treatment focuses on replacing self-criticism with awareness, compassion, and practical strategies for responding differently to urges.
Is hair pulling or skin picking caused by stress?
Stress can increase BFRBs, but stress is not the only trigger.
Many people assume they only pull or pick when they are anxious. However, BFRBs can also occur during:
- Boredom
- Relaxation
- Concentration
- Fatigue
- Emotional overwhelm
- Moments requiring sustained attention
For many individuals, the behavior serves a sensory regulation function. The physical sensation provides temporary soothing, stimulation, or relief.
This is why simply telling someone to “reduce stress” or “find a distraction” often does not fully address the problem. The behavior may be serving a specific neurological and sensory function.
Is trichotillomania an OCD disorder?
Trichotillomania and dermatillomania are classified as obsessive-compulsive and related disorders, but they are different from traditional OCD.
With OCD, compulsions are often performed in response to intrusive thoughts, fears, or a need to prevent a feared outcome.
With BFRBs, behaviors are often driven by:
- Sensory urges
- Feelings of tension or discomfort
- The desire for a specific sensation
- Automatic habit patterns
- A feeling that something needs to be corrected or removed
Because BFRBs are different from classic OCD symptoms, treatment needs to specifically address the behavioral and sensory components of these disorders.
Why doesn’t traditional talk therapy always help my hair pulling or skin picking?
Many people with BFRBs have spent years trying to understand themselves.
They may have explored:
- Stress
- Childhood experiences
- Relationships
- Self-esteem
- Emotional triggers
Insight can be valuable. However, understanding why a behavior happens does not always change the behavior.
BFRBs are maintained by learned behavioral and sensory patterns, not simply unresolved emotions.
Effective treatment focuses on directly targeting:
- Awareness of urges
- Automatic behaviors
- Sensory triggers
- Environmental patterns
- Habit loops
- Alternative responses
The goal is not only to understand the behavior. The goal is to interrupt the cycle when it occurs.
What treatments actually help with trichotillomania and dermatillomania?
Evidence-based treatment for BFRBs focuses on approaches specifically designed for these behaviors.
Habit Reversal Training (HRT):
Helps individuals increase awareness of triggers and develop competing responses when urges arise.
Comprehensive Behavioral Intervention for BFRBs:
Targets the relationship between triggers, urges, sensory experiences, and behaviors.
Cognitive Behavioral Therapy (CBT):
Addresses shame, self-criticism, and thoughts that maintain the cycle.
Learn more about CBT treatment approaches here:
https://behaviortherapynyc.com/cbt-therapy/
Acceptance and Commitment Therapy (ACT):
Helps individuals learn to experience urges without automatically responding to them.
Treatment focuses on helping the brain develop new patterns rather than relying on willpower alone.
Can I actually recover from trichotillomania or skin picking?
Yes. Many people with BFRBs have lived with these behaviors for years and have begun to believe that change is impossible.
A common thought is:
“I have tried everything. Nothing will help.”
Often, previous attempts have failed because the approach did not address the specific mechanisms that maintain BFRBs.
Recovery does not mean never experiencing an urge again. It means learning how to recognize urges, respond differently, and regain control over behaviors that once felt automatic.
Specialized Treatment for BFRBs in New York
Living with bald spots, missing eyelashes, skin damage, or repetitive behaviors can feel isolating and overwhelming. Many people with BFRBs feel misunderstood because others do not recognize that these behaviors are not simply habits that can be stopped through willpower.
Dr. Suzanne B. Feinstein is a Columbia University trained licensed clinical health psychologist providing telehealth treatment for body-focused repetitive behaviors (BFRBs), including trichotillomania (hair pulling disorder), dermatillomania (skin picking disorder), OCD, and anxiety-related disorders.
Using specialized behavioral approaches, CBT, ACT, and evidence-based BFRB interventions, Dr. Feinstein helps individuals understand their urges, interrupt automatic patterns, and develop healthier ways to regulate emotions and sensations.
You do not have to continue feeling trapped by behaviors that seem impossible to control.
Seeking Treatment
If you are struggling with hair pulling, skin picking, or other body-focused repetitive behaviors, specialized therapy can help address the underlying habit loops, sensory urges, and emotional patterns that keep these behaviors going.
To learn more or schedule a private consultation with Dr. Feinstein, call 646-345-3010 or visit:
https://behaviortherapynyc.com/