When I first started pulling out my hair, I was diagnosed with trichotillomania but no one really understood it. It was one of those things where, yes, it was listed in the DSM but that's about it. My trichotillomania was often misunderstood by professionals, offering management tips that they would give to someone who self-harms or who has obsessive compulsive disorder. It wasn't until much later that I learned what a body-focused repetitive behavior was and how I've actually had more than one throughout my life.
According to the TLC Foundation for BFRBs (an amazing foundation with tons of resources): Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior (bfrb.org).
I, very obviously, pull out my hair. It was easy to diagnose because I had bald spots all over my face and scalp. I tried to stop but I was unable to. It was negatively impacting my daily life. I checked off all the boxes. But because it was the focus of my life, my other BFRBs went undetected.
Lip Biting
When I was a little kid, maybe even before I started pulling out my hair, I remember biting my upper lip. I would push my upper lip into my mouth so that my bottom teeth could rub against it. Over time a small piece of skin from the center tubercle area (see image below) would become loose and eventually come off.
I often bit my lip while concentrating but I wasn't concerned with the behavior. I didn't get teased because no one noticed—although I was scared they would so whenever the skin was loose but not coming off with my teeth, I would use my fingers to pull it. This sometimes resulted in my lip bleeding.
Nail Picking (Onychotillomania)
Another BFRB I used to engage in when I was a little kid was nail picking. I remember looking at my nails and realizing there were layers to them. I thought to myself, Could I peel that? Much to my delight, and also horror, it was easy to peel the layers off. It didn't hurt or cause any later pain, that I can remember, but it made me feel insecure because I thought it made my nails look ugly.
Unlike my lip biting, I found myself picking my nails out of boredom. Often zoning out in class while my teacher explained something my young brain didn't care about. I know now that engaging in a BFRB isn't always due to anxiety. Sometimes it just gives us something to do. I know now that engaging in a BFRB isn't always due to anxiety. Sometimes it just gives us something to do.
Skin Picking (Dermatillomania)
When I was a teenager riddled with acne I found myself sitting in front of the mirror for hours on end. In my mind, fixing my acne meant popping every pimple (even the ones that weren't ready), and examining my face from forehead to chin and cheek to cheek. It made me feel good to know that I was doing something about my skin. The problem was that instead of having acne I was now covered in open wounds. I made myself bleed. In all actuality I wasn't fixing anything, I was making it much, much worse.
At that point in my life I had had trichotillomania for over a decade and was very familiar with the "trichotillomania trance." It occurred to me that I was falling into the exact same trance but with my skin. But I shook off any concern and told myself that all teenagers did this and that there was nothing to worry about.
I was spending hours upon hours a day in a trance-like state. Pulling out my hair from my scalp, eyelashes, and eyebrows and picking my skin. I remember my family making jokes that I was always in the bathroom for too long. I was. There were so many things I was self-soothing from and I couldn't find any other way.
Had I not learned more about BFRBs from others in the community, I might never have known that these little "habits" I had were actually a part of something more. And I'm not the only one! I can't tell you how many times I've talked about the lesser known BFRBs and people exclaim, "I do that too! I never knew it was a BFRB!" As humans we all find ways to self-soothe and many of us use what is closest to us: our body. The more we talk about BFRBs the more people are able to receive the resources and community they deserve.
Keep talking.
