How to stop skin picking and/or hair pulling

Written By Rachel Davidow

The ABCs of Body-Focused Repetitive Behaviors

Do you struggle with any of the following behaviors to the point that they cause distress or interfere with your life? Have you tried to stop, but it feels out of your control?

  • Skin picking (fingers, scabs, blemishes on the face or other areas of the body)

  • Hair pulling (scalp, pubic region, facial hair, eyebrows, etc.)

  • Nail biting

  • Cheek biting

If so, you may be struggling with one or more Body-Focused Repetitive Behaviors (BFRBs).

You may have already come across diagnostic terms such as dermatillomania (skin picking disorder) or trichotillomania (hair pulling disorder).

These disorders can feel incredibly shameful and isolating, but the truth is: you are not alone.

Many people engage in some form of BFRB. In fact, research suggests about 59% of people engage in some type of BFRB, although many cases are considered subclinical, meaning the behavior does not cause significant distress or impairment.

Prevalence of Clinical BFRBs

  • Trichotillomania (hair pulling): about 1–2 out of every 50 people

  • Excoriation disorder (skin picking): about 2–5% of the population, with roughly 75% identifying as female

  • Onychophagia (nail biting): affects about 20–30% of the general population

The good news? BFRBs are treatable.

Research shows several therapies can be highly effective, including:

  • Habit Reversal Training (HRT)

  • Comprehensive Behavioral Model (ComB)

Understanding the ABCs of BFRBs

Habit Reversal Training is an evidence-based behavioral therapy that combines awareness training with behavioral change strategies.

One helpful framework used in treatment is the ABC model, which stands for:

  • A — Antecedent (what happens before the behavior)

  • B — Behavior (the BFRB itself)

  • C — Consequence (what happens after the behavior)

When we examine these patterns, we often find that BFRBs serve a function. They are usually reinforced in some way.

For example, the behavior might:

  • Provide something positive, such as satisfaction, stimulation, or sensory relief

  • Remove something uncomfortable, such as anxiety, boredom, tension, or low mood

Understanding this cycle can help people gain insight and more control over their behavior.

Example: Understanding the ABCs in Real Life

Penelope has struggled with skin picking at her cuticles since childhood. She picks daily, often for hours at a time, sometimes causing bleeding and damage to her skin.

She hates the impact on her skin and wishes she could stop, but no matter how hard she tries, she keeps returning to the behavior.

When Penelope begins working with a therapist, she is asked to track each time she engages in skin picking. She records:

  • When it happens

  • What she is feeling

  • What she is thinking

Over time, Penelope begins to notice a pattern.

She often picks when she is bored or understimulated, particularly while:

  • driving

  • watching TV

When she picks, she describes feeling “captivated” by the sights and sensations of the behavior. She also notices a thought that frequently appears:

“This won’t be too bad this time. It’s just a little picking.”

Looking at the ABCs together, the pattern becomes clearer:

Antecedents:
Boredom and understimulation, especially while driving or watching TV.

Behavior:
Picking at the skin around her cuticles.

Consequences:
The behavior provides stimulation and engagement, relieving the unpleasant feeling of boredom.

Her thought patterns also tend to minimize or rationalize the behavior, making it easier for the cycle to continue.

Changing the Pattern

Once Penelope understands her triggers, she and her therapist work on alternative coping strategies.

These include:

  • Using fidget tools to provide stimulation

  • Covering fingers with bandages or gloves to create a barrier

  • Increasing awareness of triggers like boredom or understimulation

Over time, Penelope becomes more aware of her antecedents and feels better prepared to engage in alternative behaviors instead of skin picking.

Try This Exercise Yourself

If you struggle with a BFRB, try tracking the ABC pattern of your behavior.

When you notice the behavior, ask yourself:

  • What was my emotional state before this?

  • What situation was I in?

  • What thoughts did I have before or during the behavior?

  • What did I feel afterward?

Logging these patterns can help you understand what your behavior is doing for you and identify opportunities to respond differently.

Greater awareness is often the first step toward change.

References & Further REading

Rachel Davidow
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