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Clinical Aspects of Hair Pulling, Skin Picking, and Nail Biting

  • Eating and Other Impulse Control Disorders (J Grant, Section Editor)
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Opinion Statement

Body-focused repetitive behaviors (BFRBs) include conditions such as hair pulling, skin picking, nail biting, lip or cheek chewing/biting, thumb or finger sucking, and nose picking. Hair pulling, skin picking, and nail biting have received the most attention in the empirical literature. BFRBs are believed to reduce emotional states such as anxiety, tension, or boredom, through negative reinforcement (e.g., [1]), or to satisfy a need for sensory stimulation, through positive reinforcement (e.g., [2]). For individuals with these disorders who have impaired functioning from these behaviors, cognitive behavioral therapy (CBT) and pharmacotherapy are to be considered. The results for CBT interventions are generally favorable, whereas pharmacology interventions have shown mixed results. Habit reversal training (HRT) in particular, and interventions that have been used to enhance HRT, including acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and the comprehensive behavioral model (ComB), appear to show the most promise for BFRBs, especially for individuals who use these behaviors to control unwanted thoughts, urges, and emotions. Research on predictors of maintenance of treatment gains in hair pulling suggests that abstinence from pulling is an important factor in maintaining gains and preventing relapse. Thus, it is recommended that therapists continue treatment with patients until they are abstinent from hair pulling, which may generalize to skin picking and nail biting as well.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. OCD Institute, McLean Hospital/Harvard Medical School, 115 Mill Street, Mail Stop 207, Belmont, MA, 02478, USA

    Martha J. Falkenstein PhD

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  1. Martha J. Falkenstein PhD
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Correspondence to Martha J. Falkenstein PhD.

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Martha J. Falkenstein declares no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Eating and Other Impulse Control Disorders

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Falkenstein, M.J. Clinical Aspects of Hair Pulling, Skin Picking, and Nail Biting. Curr Treat Options Psych 3, 375–384 (2016). https://doi.org/10.1007/s40501-016-0096-3

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