Trich and Skin Picking
What Are They?
We all have little habits—twirling our hair, tapping our fingers, biting our nails during a movie’s suspenseful part. But for some people, these habits go a bit deeper. Body Focused Repetitive Behaviors, or BFRBs, are repeated actions that involve unwanted picking at or removing parts of the body, like hair, skin, or nails—often without even realizing it.
Common BFRBs Include:
- Hair pulling (also known as trichotillomania)
- Skin picking (excoriation disorder)
- Nail biting or chewing
These behaviors aren’t about “being gross” or “just needing more willpower.” They’re not attention-seeking, and they’re certainly not uncommon—millions of people experience BFRBs, many from a young age. What makes a BFRB different from a casual habit is that it can be hard to stop, can lead to physical damage, and might cause distress or embarrassment. People with BFRBs often say they feel a need to do the behavior—sometimes to relieve tension or boredom, sometimes without even realizing they’ve started.
But here’s something really important to know: you are not broken. You’re not doing this on purpose. And you're absolutely not alone.
No one knows exactly why some brains latch onto these behaviors, but we do know this: BFRBs can serve a purpose. They might soothe anxiety, give a sense of control, provide sensory stimulation, or just feel oddly satisfying in the moment. Your brain has learned, “Hey, this helps,” even if the results are frustrating or painful later on. That’s where therapy comes in—not to punish the behavior, but to understand it, work with it, and gently retrain the brain with kindness and curiosity.
What Is the ComB Model?
The Comprehensive Behavioral (ComB) Model is a flexible, individualized approach to treating BFRBs. Think of it like a personalized toolkit, created just for you.
ComB helps us explore why the behavior is happening, when it shows up, and what your brain and body are trying to achieve through it. It breaks things down into five areas (or “modalities”) that might influence the behavior. In our practice we call it STEMS:
- Sensory – Are you seeking a certain feeling or texture?
- Thoughts – Are certain thoughts triggering the urge?
- Emotions – Is this a response to stress, boredom, or anxiety?
- Motor – Is it just muscle memory or a purposeful self-soothing or both?
- Situation – Are certain settings “activating” the behavior?
Once we understand your unique pattern, we can create a plan that fits you. The beauty of ComB is that it’s not one-size-fits-all. It’s about becoming an expert on your brain and building a gentle plan to support it. ComB can be adapted for children, teens, and adults and we also work with parents of toddlers & young children (think, ages 2-6) who are engaging in BFRBs but are too young to work through individual treatment.