Trichotillomania and Skin Picking


Trichotillomania, Skin-Picking, and Nail Biting are now referred to as Body-focused Repetitive Behaviours, or BFRBs.

Trichotillomania is characterized by recurrent pulling out of one’s own hair on one or a variety of areas of the body.  This often results in noticeable hair loss.  Many hair pullers experience a feeling of tension which precedes the pulling, and a sense of relief or pleasure after the hair has been pulled out, however this is not always the case.  People may consciously choose to pull hair or engage in pulling without awareness.  Often people engage in both conscious and unconscious pulling behaviours.


Skin-picking is characterized by recurrent picking of skin on different areas of the body. Similarly, tension may precede picking, and relief may occur afterwards.  There are also unconscious and conscious episodes of picking.  Picking may take up significant time in an individual’s day and may result in scarring.

Hair pulling and skin-picking can have a significant impact on an individual’s quality of life as regular activities may be avoided due to shame or embarrassment.  This combined with lack of knowledge among health professionals can lead to isolation and frustration.  Both of these problems have also been associated with physical problems such as repetitive strain injuries or tendonitis, infections (in eyelash pulling), or in serious cases digestive problems (i.e. when hairs are ingested).

Cognitive Behavioural Therapy

There are a variety of CBT techniques that can successfully treat Trichotillomania, skin-picking, and nail biting.  York Region CBT psychologists are trained in these specialized techniques including relaxation training, habit reversal, stimulus control,  cognitive restructuring, and habit-blocking.

The Trichotillomania Learning Centre provides helpful resources and information for clients and families