If you struggle with a body-focused repetitive behavior like skin picking or hair pulling, you’ve probably tried a lot of things to stop.
Maybe some of them worked for a little while, but nothing really stuck. Nothing got you to a place where you could consistently manage the behavior.
So you start to wonder, “What’s wrong with me? Why can’t I just get this under control?”
A lot of people end up blaming themselves, thinking they’re not trying hard enough.
But the truth is, it’s not your fault.
Most people, including most therapists, don’t actually know how to help someone with a BFRB. Our instincts tell us to focus on stopping the behaviors, since the behaviors are what seem to be causing the harm. But focusing only on stopping doesn’t work.
You can stop for a period of time, but eventually you slip. Then comes the frustration, the guilt, the shame, and often more of the behavior.
It becomes a cycle.
And it’s exhausting.
When I first started my career as an OCD therapist, I couldn’t understand why people with BFRBs weren’t getting better as quickly or as consistently as those with OCD. Over the past 20 years, I’ve devoted my career to changing that.
Through my work with clients and learning from other experts in the field, I’ve realized something important. These behaviors serve a purpose. They help people regulate, soothe, focus, or get through overwhelming moments. And when we ignore that, or try to take the behavior away without replacing what it’s doing, it doesn’t work.
That shift changed everything about how I approach treatment.
Instead of focusing only on stopping, I focus on what actually leads to long-term change. The work I do now incorporates what I think of as the key ingredients for recovery: acknowledgment, awareness, targeted interventions, SMART goals, accountability, support, and self-compassion.
Here are a few things I’ve learned that actually help:
- Awareness matters, but only if it comes with compassion.
- You have to understand what needs are being met by the behavior before trying to change it.
- It’s not about trying harder, but having the right support and accountability in place to help you stay on track when you slip or feel like giving up.
- Remember that you are not the only one who struggles with this, even if it feels that way.
- BFRBs need specialized care. Not all therapy approaches work, and it’s important to work with a therapist or support group led by someone with specific training in BFRBs.
The hard part is that this kind of care is still not easy to find.
A lot of people are misdiagnosed or dismissed. A lot of providers haven’t been trained in BFRBs. And a lot of people feel too much shame to even ask for help.
That’s a big part of why this work matters so much to me, and why stepping into my role as Chief Clinical Advisor with The BFRB Foundation feels so important.
We need to expand care. Not just awareness, but real, effective support that actually works.
That’s also why we’re hosting Expanding Care: An Evening at The Center on April 11th.
It’s an open house where we’ll be celebrating a lot of meaningful growth. My co-author, Lauren McKeaney, and I will be reading excerpts from and signing copies of our new book, The BFRB Workbook for Teens and Young Adults. Our team will be there to connect, and we’ll also be sharing more about our new IOP and officially introducing The BFRB Foundation.
More than anything, it’s a chance to connect with people who understand this work and why it matters.
Whether you’re personally affected by BFRBs, supporting someone who is, or simply want to be part of something meaningful and celebrate the work we’re building, we would love to have you there. For more information or to RSVP, click here.