My Anxiety Plan for Body Focused Repetitive Behaviours

The following strategies are designed for you to use as you begin to tackle Body Focused Repetitive Disorders. These strategies are best used for adults with mild-moderate signs of this type of anxiety related disorder. For individuals with more severe symptoms or who have been diagnosed with Skin Excoriation or Trichotillomania, we recommend treatment with a mental health professional, although MAP strategies can be used at home to support your therapy work.

Step 1. Helping you become an expert on stress and anxiety

This is a very important first step, as it can help you understand what is happening in your mind and body when you experience stress and anxiety. Stress is a normal and routine part of living in the modern world, and is defined as any demand placed upon the body and mind. Stress may be both negative and positive, but only becomes a problem when we let life’s demands exceed the resources we have to cope. Resources can be both internal, such as our thoughts and feelings, and external, such as our actions, environment, friends, and family. In addition, recognizing that the worries and physical feelings you’re experiencing have a name -anxiety- and that millions of other people also have anxiety can be a great relief. Finally, the following links can further your expertise by providing you with additional facts and information: ABC's of Anxiety: Understanding How Anxiety Works & Anxiety 101: What You Need to Know About Anxiety & Anxiety 102: More Facts & Fight-Flight-Freeze & When Anxiety Becomes a Problem: What’s Normal and What's Not

Step 2: Learning the facts about Body Focused Repetitive Disorders

Reading about the information outlined on the body focused repetitive behaviours main page can help you feel less afraid of what is happening to you. After all, knowledge is power.

The following list includes some facts and highlights common to individuals with Body-Focused Repetitive Behaviours:  

  • Body-Focused Repetitive Behaviours, or BFRBs, are a cluster of habitual behaviours that include hair pulling (called Trichotillomania), skin picking (called Skin Excoriation), nail biting, nose picking, and lip or cheek biting. In both Trichotillomania (TTM) and Skin Excoriation (SE), the individual experiences ongoing and repetitive urges and actions towards either pulling out of one’s hair or skin picking (dependent on the disorder), resulting in noticeable hair loss, or skin abrasions or lesions. This occurs despite extensive efforts to stop these behaviours.
  • These disorders typically cause significant impairment or disruption in routine life functioning for the individual. Examples of negative outcomes include avoiding routine activities, missed work, problems concentrating, social isolation, and financial strain, among other examples.
  • It’s important to understand that BFRBs are not simply habits one could stop if s/he tried harder. Rather these are conditions that involve complex brain mechanisms that generate urges and actions of pulling/picking. As a result, specialized help is required to help learn how to manage.
  • Although these BFRBs can create significant stress, impairment, and interference in the life of the individual, the good news is that there is a treatment that can help. Below we outline a variety of solution-focused, practical steps designed to help you to become aware and notice the triggers that lead to pulling or picking, and engage in alternative behaviours. As a result, this will interrupt and weaken the cycle of trigger --> urge --> pull/pick --> relief --> shame, while strengthening your implementation of alternative behaviors. In addition, this treatment will also help you to challenge unhelpful ways of thinking that can contribute to urges and actions that result in either pulling or picking.

Step 3: Creating your Body Focused Repetitive Disorder MAP

The best way to help you deal with TTM or SE is to learn specific tools that can be used to cope with the symptoms, urges, and behaviours associated with hair pulling or skin picking.  These tools are intended to increase your ability to tolerate stress and anxiety, rather than to eliminate stress and anxiety, which accompanies urges and actions associated with both TTM and SE.  Stress and anxiety exist everywhere, and therefore it is an illusion to believe we can eliminate the source and experience of these emotions. It is far more effective to provide yourself with the tools to tolerate and cope, rather than to control and escape.  For TTM or SE, you can use any or all of the following anxiety tools to create your MAP (My Anxiety Plan). These tools are listed in a recommended order, although proceeding in this order will depend on your needs and interests. For TTM and SE, Stimulus Control and Habit Reversal Training, will be two of your most important tools to obtain relief from your symptoms.

NOTE! Treatments for TTM and SE continue to be modified to incorporate new strategies to optimize outcome. Outlining the strategies and application of all aspects of CBT treatments for TTM and SE is beyond the scope of this section. However, be aware that Acceptance and Commitment Therapy, and Dialectical Behaviour Therapy, are two other efficacious CB treatments that have been developed successfully for TTM and SE.

Final point: Although increased knowledge and the many tools available on this website can be very effective in helping you to manage your BFRB, sometimes it is not enough. Some adults have very severe symptoms caused by their BFRBs, and despite all their best efforts, they might still be struggling daily with these symptoms. If this is the case for you, we recommend you seek professional help through a consultation session with your family doctor, psychiatrist, or a psychologist/mental health worker.