The Most Common BFRB Question: Can I really stop picking/pulling?

For more blogs, webinars & other useful materials on body-focused repetitive disorders, join our BFRB Club for FREE and get support on your journey toward healing.

Probably the most common question I get in my inbox or from my new clients who struggle with body-focused repetitive behaviors is: can I really stop picking my skin/ pulling my hair?

The short answer is, of course, yes. If change wasn’t possible, I wouldn’t be in the business of helping people change.

Body-focused repetitive behaviors have a habitual component to them and habits, although stubborn and difficult to change, can be changed. The process requires patience, discipline and dedication, but it can be done.

It’s never that simple

But there’s more, or I wouldn’t be writing this blog. Just like any symptom, any habit, any problem, any type of behavior, skin picking and hair pulling have a role to play, they have a function in our psychological life.

To put it in more constructivist terms, they are elements in one or more constructs and, therefore, have a meaning, a place in your psychological life. As hard as it is to believe, but BFRBs play an important role.

This probably won’t tell you the whole story, but most people will easily recognize that skin picking, hair pulling and other BFRBs have a soothing effect. As painful and difficult as these behaviors may be, having in mind all the damage that they do and suffering they cause, they provide a useful service.

Self-soothing that BFRBs provide is a normal, natural need. Animals need it, humans need it. There’s no way around it and no need to go around something that’s a part of our shared repertoire of needs. There are two questions that you can ask yourself here:

1.       Do I need more self-soothing than an average person and if so – why?

2.      What makes your BFRB a better way to self-soothe than anything else in your skill set?

An honest look into these two questions can tell you a lot. You can learn about bigger changes that you need to make, changes to your approach to the world, your relationship to your inner life (your inner world itself), your lifestyle. These can be painful and hard to come to terms with, as one of my clients recently said “when I think about having to curb my ambition to stop picking, it almost makes it seem like all the scars are worth it”.

The second question can tell you about your BFRB’s stubbornness and persistence, what makes it so hard to get rid of. We choose those behaviors that offer more advantages, so in order to change them, you need to learn what those advantages are.

The urge

When I say what I wrote above, it usually goes well. Even if some of this thinking is new, it’s usually not difficult for people to grasp. But then we come to the urge and that’s where I can’t promise them that it will go away and we run into our first problem.

Not because I think the urge to pick or pull is awesome and should always be there, but because I have a different relationship to feelings than most of my clients. As a constructivist, I see feelings as constructions. They are very much real but they are not burden we have to withstand or something we should run away from. Instead, I see all our feelings – urge to pick or pull included – as information, but information delivered with symbols that aren’t words.

The same way you can have an anxiety disorder and you’ll never rid yourself of anxiety because anxiety is a normal part of our experience as humans, you can have depression and heal from it but you’ll still be sad sometimes, you might also experience the urge to pick/pull long after you get rid of the behaviors themselves.

Why?

Because urges carry information. They are telling you that you are currently in need of self-soothing. You can perhaps reduce them by organizing your life in such a way that you encounter fewer stressful situations or you can work on being more resilient, on mindfully paying attention to your emotions and dealing with issues before urges appear, but this annoying feeling we call the urge will rear its ugly head and there’s no way around it.

Because of this, therapy can’t be directed only towards replacing one habit with another or finding “hacks” to quit quickly. Therapy always has to involve a more fundamental set of changes. I always make sure to work on helping my clients re-frame their view of their own internal experiences and befriend their emotions, especially when they are difficult, because it’s those emotions that can teach us the most.

Temptations

We never know what life may bring and, in the future, you may encounter terribly stressful situations. I hope you don’t, but judging by the past few years, I think it’s safe to say that most of us can’t possibly assume what’s ahead.

When things get really tough, when they get so tough that we run out of “mature” ways of dealing with pressure, anxiety, stress, etc. we might resort to older behaviors that can help in such situations. Some call this regression. We’ve all seen grown man behave like children – that’s a common, good example.

Old behaviors never die. They stay with us, in a dark corner of our psyche and wait to be invited back. Once all newly acquired mechanisms fail, you may, in your thoughts, turn back to your BFRB. And in order to prevent relapses like that, I always insist on my clients re-defining their relationship to their thoughts and emotions. Without going into details (it’s a topic for another blog), the idea is to come to that point that Buddhist meditation teachers often describe as “don’t believe everything you think”.

To summarize…

Can you stop picking/pulling?

Yes, without a doubt.

Will you have to change your expectations for what treatment brings?

Very likely, if you expect that you can decide what feelings you have.

Will you have to treat BFRBs are more complex problems than mere annoying habits?

Absolutely.