What is BFRB?
Chronic skin picking and hair pulling aren’t just hard to break habits, they’re psychological disorders. Excoriation disorder and trichotillomania are known as body focused repetitive behaviors (BFRBs) and can be symptoms of ADHD, OCD, and anxiety. A genetic component may also be at play as these behaviors are often observed in first-degree relatives. BFRBs are often exhibited in times of stress, anxiety and boredom as a means of self soothing.
what does it look like?
Chronic skin picking looks like repeated failed attempts at stopping the picking of a patch(es) of skin. While engaging in picking, the behavior might go unnoticed or be an area of hyper focus. Chronic skin picking does result in lesions, but is not considered a form of self harm. Commonly affected areas include fingers, arms, feet, face and lips, scalp, and back. Like skin picking, chronic hair pulling persists despite attempts to stop, and feelings of shame or guilt may arise after engaging in the behavior. People with trichotillomania tend to pull out their eyebrows, eyelashes, head hair, and/or body hair. BFRBs cause clinically significant distress or impairment and the symptoms are not caused by a substance, medical condition, or dermatological condition.
How Art Therapy Can Decrease Symptoms
Mindfulness-based art therapy is used to help decrease symptoms of BFRBs through increased consciousness. Mindfulness based art therapy emphasizes the awareness of thoughts & emotions and how they feel in the body. The therapist engages the client in both art and cognitive-behavioral interventions that help them explore and track thoughts, feelings, and stimuli that signal the urge to pick skin or pull hair. This approach helps the client identify their triggers and in turn implement effective coping skills. Mindfulness-based therapy is aimed at decreasing maladaptive behaviors (coping behaviors that are harmful to the self) through increased consciousness. Art therapy in particular is helpful for treating BFRBs, as it keeps the fingers busy and involves a release of energy.
Art interventions for BFRBs
Mandala drawings can be done at home or in an art therapy session to help relieve stress and increase mindfulness. Drawing and coloring, as a repetitive activity, helps to keep the brain occupied while hands remain focused on something other than picking skin or pulling hair. Brain dumps are another art intervention used to promote mindfulness. Through the use of drawn elements and/or collaged images, the client can identify BFRB triggers and represent them visually on paper.
helpful prevention tools
Mindfulness-based art therapy can be an effective approach for decreasing symptoms of chronic skin picking and hair pulling, and may work well in conjunction with other tools. Finger cots can be sold online or in stores in silicone, fabric, and other materials. Covering the thumbs and fingers makes it harder to use them for picking and pulling, and can decrease visual and textural stimuli that stimulate BFRBs. Balms and lotions can be applied to dry and rough skin to also reduce stimuli, as well as soften the area, heal the skin, and limit accessibility to the area. Pimple patches can be put over acne, scars, and other areas to prevent picking. Fidget toys and art materials such as Model Magic can also be utilized to help keep the hands busy in times of stress.
Kamryn Aaronson, LCAT-P is provisionally licensed in New York State as a creative arts therapist. They have a degree in creative arts therapy from Nazareth College. They have been practicing art-based psychotherapy since 2024 and currently see clients at Spotted Rabbit’s Pittsford, NY studio.
Kamryn specializes in working with youth and adults with BFRB and other obsessive compulsive tendencies, anxiety, neurodivergence (autism, ADHD, OCD), depression, and trauma.