What helps with hair pulling and skin picking disorders?
Okay. So maybe you’re aware it’s not a willpower problem. (If you missed a post I wrote about that, you can read it here)
And the next question is usually something along the lines of: "Okay Lori, so what really works? How do I stop doing this?"
It's not "you should distract yourself." I've had clients come in after trying every “fix” they found on the internet, and none of it stuck, because none of it was necessarily designed for them.
Here's what can truly help move the needle:
First - Treatment Isn't One-Size-Fits-All (That's the Whole Point of Individualized Therapy)
The reason generic advice fails is that hair pulling and skin picking, known clinically as body-focused repetitive behaviors (BFRBs), aren't driven by one single thing. For one person it might be sensory - something about the sensation itself. For another it may be a looping thought: "this one has to feel just right." For someone else it may be boredom, or it possibly only happens in a specific spot in the house.
All of that means real treatment starts with figuring out your specific patterns - not handing you a script or a stress ball that worked fine for someone else.
The Assessment: Understanding Your Pattern
Before we talk tools, we map the behavior. It usually looks like behavior tracking:
When and where it happens (couch, car, bathroom mirror, in bed at night)
What's happening right before - not "trauma," but the actual trigger. (Got home from work. Sat down to scroll. Felt bored.)
What it feels like in the moment - is it more automatic, where your hand is just there before you even notice? Or is it more deliberate, where you're intentionally searching for "the right one" or “the right spot”?
Most people do both. But knowing which one you're doing, and when, will change what’s going to help you.
The Tools - Matched to What's Actually Driving It
Once we know the pattern, we can build a toolkit across a few different areas:
Sensory tools - something that gives your hands or skin a similar sensation, safely. A textured object, a hairband to snap or pick at instead, a specific fidget that scratches the itch (literally!).
Cognitive reframes - a coping card or a specific thought to interrupt the "this one has to feel right" thought in the moment.
Emotional regulation tools - if boredom or anxiety is a trigger, we address the feeling directly, not just the behavior on top of it.
Environmental changes - sometimes it's as simple as changing the lighting in a bathroom, or moving where you sit to watch TV, because certain environments can make the behavior far more likely to occur.
For kids - most of the treatment remains the same, but addressing the home environment and how a family responds is incredibly important
Something people often get wrong: they try one tool, it stops working after a week, and they assume treatment failed. When, in reality, you usually need several tools working together - and you'll rotate them as some stop being effective and others take their place. It’s a normal (and important!) part of the treatment & recovery process.
The Detail That Can Make or Break Treatment
This is the part almost nobody talks about: your tools have to be physically there in the moment, not just something you’ve talked about or remember to do later that day.
If your fidget/tool is in a drawer in another room and the urge hits you while you’re on the couch, it's not going to get used. The single biggest reason this kind of treatment doesn't work is "out of sight, out of mind" - so part of what we build together is making sure you have what you need in every place you're likely to need it. Couch. Car. Bathroom. Desk.
What Success Actually Looks Like
I really want to take a minute and reset your expectations, because it matters. The goal isn't to "never pick or pull again."
Success is about reaching for a tool instead of the picking or pulling behavior - even just sometimes, even if the urge is still there. If you use an intervention fifty times in a week, that's fifty times you didn't engage in the behavior, even if it still happened other times. That's the progress we’re working toward. That's how BFRBs get better: the urge weakens over time and it stops consuming you and causing your hair or skin the damage it has in the past.
You don't have to figure this out alone, and you don't have to keep searching for random tips on Reddit threads hoping that one will finally stick.
If you struggle with one of these behaviors and you’re ready to explore it, book a free 15-minute consultation and we can work on it together.
Talk soon, Lori
Hair pulling and skin picking are close relatives of OCD, not the same condition - but if checking, rumination, or intrusive thoughts also sound familiar to you, OCD is something I work with.
Written by Lori Streator, Licensed Therapist & Board Certified Bariatric Counselor (BCBC)
Lori has 20+ years of clinical experience specializing in anxiety therapy, high-functioning anxiety, emotional eating, and bariatric counseling for women. She serves clients in Bradenton, FL and online across Florida and Illinois, owns Solaire Therapy & Wellness, and hosts the Let's Talk About It with Lori Streator podcast.