Hair-Pulling & Skin-Picking

Help for body-focused repetitive behaviours (BFRBs), for adults, teens, and children.

If you pull out your hair, or pick at your skin, and you have tried more times than you can count to “just stop,” I want to begin with something you may not have heard enough: this is not a willpower problem, and you are not the only one. Hair-pulling and skin-picking are recognised conditions with real, well-studied treatments. They respond to the right approach. They rarely respond to shame, and you have probably already proven that to yourself.

These behaviours have a clinical name: body-focused repetitive behaviours, or BFRBs. The two most common are trichotillomania (hair-pulling) and excoriation, sometimes called dermatillomania (skin-picking). In the DSM-5 they sit in the same family as OCD, though they are not the same thing. Most of the people I see have carried them quietly for years, often since their teens, and often alongside anxiety, ADHD, or a perfectionism that runs hot.

What body-focused repetitive behaviours actually are

Trichotillomania hair-pulling	Recurrent pulling out of your own hair, from the scalp, lashes, brows, anywhere, enough to cause hair loss and distress. The DSM-5 puts it at roughly 1 to 2 percent of people.
Excoriation skin-picking	Recurrent picking at the skin that leaves wounds or scarring. At least as common as hair-pulling. Both often begin around adolescence and can quietly run for decades.

What they are not is a bad habit you should be able to break by trying harder. For most people the behaviour is doing a job: soothing, stimulating, releasing tension, or filling a moment of boredom or stress. That is what makes it so sticky, and it is also the key to treating it well.

Why “just stop” has never worked

Pulling and picking are often partly automatic, something your hands do while your mind is elsewhere, and partly soothing, something that genuinely settles a feeling in the moment. Advice like “wear gloves” or “just notice it” tends to fail on its own, because it fights the surface and ignores the function. The work that actually holds is understanding what the behaviour does for you, and then building something that meets that same need in a way you can live with.

What actually helps

The best-established psychological treatment for BFRBs is Habit Reversal Training (HRT), usually delivered inside the broader Comprehensive Behavioral model, known as ComB. It is practical, structured, and collaborative. In plain terms, it has a few moving parts:

Awareness training	Catching the behaviour earlier, and mapping where it happens, when, and what feeling tends to come just before.
A competing response	A small physical action that is incompatible with pulling or picking, used and held until the urge passes.
Stimulus control	Adjusting the situations and objects that quietly make it easy, so your environment starts working for you rather than against you.
The individualised piece	ComB maps your own pattern across your senses, thoughts, feelings, movement, and the places it happens, because no two people who pull or pick are the same.

This is not guesswork. Habit reversal is the best-established behavioural treatment for hair-pulling and skin-picking,¹ and the ComB model showed benefit in the first randomised controlled trial of the approach.² Some people are also helped by medication. That is a doctor’s decision, not mine, and I am glad to work alongside your psychiatrist or GP if medication is part of your picture.

What is the most effective treatment for hair-pulling or skin-picking? The most evidence-based treatment is Habit Reversal Training, usually delivered within the Comprehensive Behavioral (ComB) model. It builds your awareness of the behaviour, gives you a competing response to use when the urge hits, and changes the situations that trigger it. Medication helps some people and is decided together with a doctor.

Children and teenagers who pull or pick

If you are a parent who has just found a bald patch, or caught your child picking, please try not to panic, and please try not to punish it. Shame and consequences almost always make a BFRB worse, because they add secrecy on top of the behaviour. The encouraging part is that the same approach works gently with children and teenagers, adapted to their age and done with them rather than to them. I involve the young person, keep it free of blame, and coordinate with school where that helps.

How I work, and what it costs

Free 15-minute Meet and Greet	Ask questions and we both feel out whether I am the right fit.
First consultation	Usually up to two hours, typically SGD 700. I understand the full pattern, what you have tried, and what is keeping it going.
Ongoing sessions	60 to 90 minutes at SGD 350, pro-rated, usually weekly to begin with.

You will not be in therapy forever; the aim is to get you the tools and then get out of your way.

Hair-pulling and skin-picking belong to the family of OCD and related disorders, and it is work I stay close to. I am a Professional Member of the International OCD Foundation (IOCDF), which keeps me current with the evidence for treating body-focused repetitive behaviours and the conditions that often sit alongside them.

A note from me

I have ADHD myself, so I know what it is to have a brain that does its own thing, and I know how heavy the shame around these behaviours can become. You will not find any of that shame in this room. What you will find is someone who takes the problem seriously, knows the evidence, and treats you like the capable person you are.

If your main concern is tics or Tourette’s rather than hair-pulling or skin-picking, that work has its own page here.

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1. Habit reversal is supported by systematic-review evidence as the best-established behavioural treatment for body-focused repetitive behaviours. See the systematic review of habit reversal therapy in obsessive-compulsive and related disorders, Frontiers in Behavioral Neuroscience (2019).
2. Carlson, E. J., et al. (2021). Comprehensive Behavioral (ComB) Treatment of Trichotillomania: A Randomized Clinical Trial. Behavior Therapy, 52(6), 1543–1557.

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Next steps

If you have spent years being told to just stop, you already know that advice does not work. Fifteen minutes is enough to talk about what actually helps.

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