Opinion: Breaking the Silence on Body-Focused Repetitive Behaviours

By Sebastian Siwiec, Full Time Counsellor – Calgary Counselling Centre

How many times this week have you twirled your hair, plucked an eyebrow, or picked at a scab? Or have you popped a pimple and didn’t give it a second thought? For 95 per cent of the population, these are normal, harmless and sometimes even enjoyable grooming behaviours. However, for others, these otherwise normal behaviours become expressed in a manner that causes them significant harm and distress. This disorder is classified as a body-focused repetitive behaviour (BFRB).

Trichotillomania (hair-pulling disorder) and excoriation disorder (skin-picking disorder) fall into a category of BFRBs. According to the Trichotillomania Learning Centre, in per cent of the general population that experience either one or both of these conditions, BFRBs can cause significant amounts of shame and distress. In large part, this shame and distress is brought about by our general misunderstanding and the secrecy of these conditions.

I’d like to discuss trichotillomania and excoriation disorder as these are two particular areas of interest for me as a counsellor and is something I am taking advanced training for. In addition, it’s important to raise the issue as this week is BFRB awareness week (October 1-7).

With trichotillomania, a person will repeatedly pull hair from a number of areas such as the scalp, eyebrows, or eyelashes, and genital area in turn causing bald patches. What is distressing to people with trichotillomania is not only the visibility of these bald patches, but that they might not even be aware of what they are doing. In cases where a person is aware, they can experience significant distress in trying to stop the behaviour. With excoriation disorder, people will pick at scabs, acne, ingrown hairs, and other wounds to the point that it causes even more damage to the skin.

This behaviour creates visible markings – whether in the form of bald patches or skin wounds – which can create a lot of anxiety when interacting with others. In fact, people with BFRBs often report avoiding situations that might reveal the condition or they become masterful at covering the affected areas as much as possible with clothing, wigs, or carefully groomed hairstyles. So, the chances that you have encountered somebody or even know somebody with a BFRB are very good. While this camouflage keeps the person feeling safe from feeling judged or standing out, it’s precisely the reason why these people suffer alone.

What cannot be stressed enough is that help and assistance is available for people with BFRBs. Working with a therapist can assist in untangling the mystery about BFRBs and helps you develop a self-compassionate attitude toward yourself. Therapists also help loved ones understand the condition and give them effective tools to offer support and address the behaviour. It can be so difficult to reach out, but I encourage you to break the silence because nobody should experience a BFRB alone.

For additional information about BFRBs please visit the Trichotillomania Learning Centre ( or the Canadian BFRB Support Network (www.

Sebastian Siwiec wrote his thesis on trichotillomania and is currently training at the Trichotillomania Learning Centre.

Category: Blog, Community.

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