#Trichophagia

[thatoneluckybee]

Tips for Writing Characters with Trichotillomania

- Someone with trichotillomania (hair-pulling disorder!)

I’m really glad that people are starting to realize that BFRBs actually exist! And with that, I’m happy that this means it’s not JUST me headcanoning characters to have BFRBS or CREATING characters with BFRBs. HOWEVER. With this, it is important that these disorders are represented well. I have trichotillomania myself, so here’s a list of things that I look for in characters and when making my own, and tips for accurately portraying a BFRB!

This is focusing on trichotillomania as I have it. I might make some on other BFRBs but I’ll have to do a lot of research and talk to people or read accounts of people WITH the specific BFRB. (I pull my hair and bite my nails, so I cannot about other BFRBs I don’t have off the top of my head.)

What IS a BFRB?

BFRB stands for “body-focused repetitive behavior.” BFRBs are a group of disorders listed in the DSM-5 under “Obsessive-Compulsive and RELATED Disorders.” BFRBs are NOT OCD. They are closely related, but are DIFFERENT things! A BFRB is defined by bfrb.org as a “repetitive self-grooming behavior…that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior” and WebMD as “intense urges…that can cause damage.” (A BFRB is NOT the same as self-harm!!!!) In short, a BFRB is a behavior or habit that hurts you and is nearly impossible to stop or control. The easiest way I’ve found to describe it is like pressure. Next time you have an itch, try not to scratch it. It’s difficult! It feels like a pressure building up. Now, imagine that “itch” is really the INTENSE urge to pull out your hair, pick at your skin, bite at your lips, and the like. THAT is a BFRB.

What about Trichotillomania (or Trich)?

There are two main types of hair-pulling: FOCUSED and AUTOMATIC. Oftentimes, people’s trich does not neatly fit into one category. One trichster can engage in both (like me!) or it could depend on the location of the hair on your body. Focused means you are AWARE that you are pulling when you pull. AUTOMATIC means you are NOT AWARE that you are pulling.

Secondly, trichotillomania DOES NOT DISCRIMINATE. People can pull from ANYWHERE and EVERYWHERE. Oftentimes people who mention trichotillomania only consider pulling from your scalp. But we, as human beings, are mammals. There is hair everywhere. Other common places include eyebrows, eyelashes, the pubic region, underarms, arms, and legs. But if there is hair at ALL, trichotillomania can cause you to pull it. Some people have specific locations they pull from, and not EVERYONE pulls from EVERYWHERE! (For example, my scalp was never an issue until this past year, and I have had this BFRB for several years. It began with my lashes, then progressed to my legs and brows. I pretty much have trich for everywhere now. Yay.)

ONTO THE TIPS

For many, trich can be a self-soothing behavior. If a character has trichotillomania, they may gravitate towards their hair when they are startled or under stress, even if they are not pulling. An example of this could be a character running their fingers through their hair when anxious, or running their fingers over their eyebrows when frustrated.

A BFRB is not something to be ashamed of. However, there is a LOT of stigma around them. Many trichsters WILL attempt to hide their BFRB from people, especially strangers. Even the most kind-hearted, honest cinnamon roll may lie to a loved one about why their hair is thinning or why their arms are sore. Some common ways of this are wearing hats or styling one’s hair a certain way, wearing pants and long sleeves, or avoid hairdressers and doctors.

IT HURTS. There is often PHYSICAL PAIN that accompanies trichotillomania! What inspired me to write this post was quite literally me being grumpy because I was having to hold a towel to my arm because I dug too deep trying to get an ingrown hair and it bled more than expected. Pulling, especially if it’s from sensitive areas of your body like your nose, pubic region, fingers, feet, eyelashes, etc. where there are many nerves, can HURT. There will likely be red, bumpy skin. There may be blood. There may be scars.

There is going to be hair everywhere and yes it is annoying and no it’s not stopping anytime soon. Vacuums will clog. You will get hair stuck to the soles of your feet when you take off your socks. It’s gonna be everywhere.

Some people will chew on or eat the hair. This is known as trichophagia. I do not know much about trichophagia as I do not have it myself. However, I DO know that people with this can experience issues like stomachaches, indigestion, and the like. That’s okay. That’s normal.

You cannot love someone’s trichotillomania away. Please, please, please do not do this. You can help someone if they want it, you can love them, you can try, BUT THIS IS A DISORDER. It is NOT a choice. It is not something a character needs to “try more” with. I see a lot of posts under the trichotillomania tag here on Tumblr that are excerpts of fics. 99% of the time, it’s Person A forcibly stopping Person B from pulling and begging them to stop “for them.” I am not saying there is something inherently malicious about these! But someone cannot just stop “for you.” I’m sorry. It’s still a disorder. Please avoid the “stop for me!” trope if possible, or at the very least avoid this being the “cure-all” for a character’s BFRB.

These disorders are so widely misunderstood and underrepresented. There is a lot of misinformation. Please do not shy away from creating characters with a BFRB, in fact I highly encourage it! But pleasepleaseplease do some research beforehand and listen to people with these disorders. Good luck!

[xan-the-emo-trans-man]

it’s “mental health matters”

until it’s something that scares you or has symptoms you can’t romanticize

[general-sleepy]

[TW: Trichotillomania/BFRB discussion]

I randomly ended up reading about decoupling, decided to give it a try, and I haven't pulled or eaten my hair in two days. My mind is kind of reeling right now.

Decoupling is a technique for treating BFRBs where you redirect the motion that's usually associated with the behavior you're trying to stop. For example, if you bite your nails, when you're in the process of bring your finger up to your mouth, you would instead touch your earlobe or another part of your face.

For me, when I'm reaching to pull a hair, I instead press the palm of my hand to the back of my head. It's especially useful because it gives me the satisfying sensation of touching hair, which no kind of fidgeting can replace, but in a harmless way. It shuts down the impulse in a way that just stopping doesn't; I think it's because it feels like the gesture is "completed" in a way, not left unfinished.

The impulse is still there, I think especially because it doesn't address the hair-eating element of the behavior, but thusfar I've been able to shut it down effectively. We'll see how this goes.

[syrips]

even when im super sad i still managed to cope in a super healthy way and im so proud of myself

below is trichotillomania recovery stuff

i havent picked my scalp/face for a whole week and im so proud!! i bought myself an obnoxiously bright beanie and its so chaotically vibrant that it makes me smile and keep it on to protect my scalp

tempted to put pins or embroider it so it makes beanies more enjoyable to wear but this is a lovely start

my eyes may be swollen from tears but my scalp has baby hairs!! 💜

[sunnyxjarrus]

yes I do want to rip every hair out of my scalp but no I am keeping my hands busy

wait where did half my eyelashes go?

Nope hands busy

there’s no eyebrows anyway stop picking the little hair that is growing

HANDS BUSY

make the scarf follow your pattern

keep your hands busy

[femmeterypolka]

meal of choise

[swampvoid]

*Partially open - as in I share it with small faction of trusted people (close friends, family, partner/s);

**open online - on any social media of choice, I share in BFRB support spaces, shared in private messaging with internet friends

This is no professional survey.

[sadririko]

I am just so tired and I feel like a worthless piece of shit. At least I look cute lol

[prince-of-cats]

I’mmmmm notttttt doing welllllllllll ick ick ickkk, tore a chunk outta my hair and I stilk have to eat more and one day the surgeons’ll have to cut me up and I’ll have to pay for that and fuck

[nobutseriouslywhat]

Ohhhhhhh this better not be what I think it is

[totalfreakingloser]

i should start writing and posting medical papers but starting them all with a disclaimer that i am not a medical professional (anymore) and i just think this was neat and i needed to study it because regular people don't want to talk about pica or trichophagia i guess

[syrips]

i really wanna make my trich pc. i have a wig-wearing pc but i wanna make a trich/hair one. aaa-

anyways below cw warning

cw: trichotillomania coping/meme

how it feels to pluck for 5 hours: wow, time sure flies, huh!

how it feels to not pluck for 5 minutes: AAAAAAAAAAA-

[wolfbitingstarboy]

BFRB Resources for Struggles Like Ours

These resources vary from reliable sites and blogs to published journal articles, professional papers, books, and more. If you have any recommendations for me, feel free to Submit something.

A separate post for tips, tricks, and non-affiliate product recommendations will be linked here as soon as I've posted it.

Now then, some of you may be wondering...

What is a BFRB?

Body-focused repetitive behaviors are among the most poorly understood, underdiagnosed, and untreated group of mental health disorders.

According to the TLC Foundation for BFRBs:

"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."

(From the TLC Foundation's webpage, "What is a BFRB?")

The PickingMe Foundation says:

"BFRB's are self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body. Many people are more familiar with its sister disorder, Trichotillomania - Hair Pulling Disorder."

(From the PickingMe Foundation's webpage, "What is Dermatillomania?")

The Recovery Village describes BFRBs as:

"Body-focused repetitive behaviors (BFRBs) are a group of mental health conditions that cause people to bite, pick, pull or scrape their skin, hair or nails compulsively. While some people with BFRBs have awareness and insight into their behaviors, others do them automatically. BFRBs are often linked with disorders like anxiety or substance abuse. Treatment is essential for people with BFRBs, but many often hide evidence of these harmful actions and have trouble asking for help."

(From The Recovery Village's webpage, "Body-Focused Repetitive Behaviors")

According to Angela Hartlin's skin-picking support website:

Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” The key difference between BFRB and other compulsive behaviours that cause harm to the body is that BFRBs are characterised by direct body-to-body contact. The website goes on to list other BFRBs such as: hair-pulling disorder (trichotillomania), hair eating disorder (trichophagia), skin biting disorder (dermatophagia), nail biting disorder (onychophagia), and nose picking disorder (rhinotillexomania).

Getting BFRBs officially classified as disorders has been a long, slow process that only hurts those of us who struggle with them daily, as treatments and available resources relating to BFRBs can be very difficult to find. That's the reason why I'm composing this. I'll keep updating this post to the best of my abilities, both for myself and for anyone else it might help.

The good news is that while progress may be slow, there is still progress. Dermatillomania was finally added to the DSM-V-TR under the same OCD-Related Disorders umbrella as Trichotillomania, which has been a big step in the right direction. The more awareness brought to BFRBs, the sooner more can be recognized for what they are so the people suffering from them can receive proper medical and psychiatric help where necessary.

Are BFRBs a type of self-harm?

No.

While the two are not mutually exclusive, the general consensus seems to be that where self-harm is voluntary, BFRBs are grooming behaviors that have gone awry to the point that they are categorized as "OCD-Related Behaviors" in the DSM-V-TR due to their compulsory nature. These behaviors may or may not be driven or worsened by anxiety.

In the case of BFRBs, even though these behaviors cause varying degrees of bodily harm, they're ultimately driven by impulses and urges that cannot easily be controlled. Quite often the triggering event is discovering a physical imperfection in any way for any reason and attempting to "fix" it, despite the behavior being counterintuitive to the goal. The resulting behavior can occur actively or passively, with severe active episodes usually likened to being held hostage in your own body.

There is no desire to harm and very little ability to stop, and then all of it is followed by distressing feelings such as shame, guilt, or embarrassment. We try so hard to "break the habit" that we ultimately beat ourselves up mentally for "failing" yet again. Even though many of us might know we can't control it, it's too easy to blame ourselves for something we feel is somehow our fault.

[Please be advised the purple paragraphs below are personal examples with a few details that may be triggering for some.]

For example, the only way I can come out of bad episodes is when my bodily literally cannot continue. This may look like my back giving out from leaning on the counter in the bathroom, or my legs going completely numb from sitting for too long, or (much more commonly) my fingers or nailbeds hurt too much for me to keep using them, regardless of how much I may or may not have bled.

This is always followed up by what I call the "walk of shame" phase as I clean up every injury, apply Neosporin or other balms/salves, and bandage what I can. I've burst into tears before when I had to use Neosporin like it was lotion in order to cover everything, because I had too many wounds on my arms to be able to safely apply bandages/plasters.

No part of that process, from the trigger response to the cleanup, is something I want to do. If I had a say in it, I'd never pick or bite ever again, and my skin would finally be able to heal.

Self-harm, on the other hand, is a term reserved for bodily harm that is deliberately inflicted on oneself, usually as a way of dealing with difficult emotions, memories, situations, or experiences. Instead of acting on an uncontrollable compulsion, this type of harm stems from a different set of triggers, many of which relate to trauma or other disorders. This makes the behavior more of an unhealthy coping mechanism for people in pain who are desperate for release from those feelings.

Note: If you are unsure if your behaviors are a result of a BFRB or self-harm, Crisis Text Line is a good resource:

"Self-harm is serious. And, while the intention behind self-harm usually is not death, it can still be dangerous—both physically and emotionally. Talking to someone who can help you find alternatives is incredibly important. Of course, you can start by texting us. Also, consider telling someone you know who can help you connect with a professional."

General BFRB Resources:

Sites:

The TLC Foundation - "The TLC Foundation for Body-Focused Repetitive Behaviors helps end isolation and shame for people experiencing hair pulling, skin picking, nail biting, cheek biting, and associated behaviors." They feature a robust website full of information on all BFRBs, including "Medications for BFRBs" and "Evidence-based Therapeutic Treatment for BFRBs."

The Recovery Village - "The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals." (BFRB-specific information can be found here.)

SkinPick.Com - While this site is centered around skin picking/excoriation disorder/dermatillomania, they have excellent resources for other BFRBs as well, including their Glossary page, "Complete List of BFRBs," and the blog section for "Related Disorders." I have also listed their site in the Dermatillomania section below.

Articles:

Online Journal: International Journal of Environmental Research and Public Health, Special Issue: "Body-Focused Repetitive Behaviours (BFRBs). Risk Factors, Prevention, Treatment"

The Recovery Village’s article, "7 Myths About Body-Focused Repetitive Behaviors"

The Recovery Village’s article, "8 Little Known Facts About Body-Focused Repetitive Behaviors"

Outreach:

"Health Education & Community Programs" (the TLC Foundation)

Communities & Support:

PickingMe Foundation's Online Support Group.

TLC Foundation's Support Group Directory for peer-led support groups.

SkinPick's online Forum.

Self-Help:

Nathan Peterson's ComB Model for BFRB Treatment, Part 1 and Part 2 on YouTube. Peterson is a licensed OCD specialist who helps people with OCD, anxiety, and BFRBs in person, through his OCD & Anxiety YouTube channel, and through his site, OCD-Anxiety.Com. (His BFRB specific course can be found on his site here.)

SkinPick's free self-guided program to stop skin-picking.

PickingMe Foundation's Derma Resource Packets "...are our campaign to spread Dermatillomania awareness to skin care providers (Dermatologists, Estheticians, Nail Salons, Clinicians), mental health professionals, and anyone who wants more info! We provide them with tools and the opportunity to point Skin Picking Disorder sufferers in the right direction."

PickingMe Foundation's Management Tips page, a "growing list of tips and management strategies!"

Mobile Apps:

SkinPick App – "A free tool to monitor your skin picking behaviors."

Specific BFRB Resources:

Onychophagia:

Not every instance of nail-biting is considered onychophagia. Most nail-biting behavior dissipates over time. It’s when it doesn’t that the behavior requires a closer look. Chronic nail-biting is categorized as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

SkinPick's blog post, "Onychophagia: More Than a Nervous Habit"

"Art of Prevention: The importance of tackling the nail biting habit," authored by Mohsen Baghchechi BS, Janice L. Pelletier MD, FAAP, Sharon E. Jacob MD, FAAD, FAAP. Published in the International Journal of Women's Dermatology, Volume 7, Issue 3, June 2021, Pages 309-313.

"Update on Diagnosis and Management of Onychophagia and Onychotillomania," authored by Debra K. Lee and Shari R. Lipner. Published in the International Journal of Environmental Research and Public Health, 2022, 19, no. 6: 3392.

Dermatophagia:

Formerly referred to as "wolf-biting," dermatophagia has yet to be recognized as a diagnosable disorder.

SkinPick's blog post, "Do you eat your own skin after picking? There's a name for that."

SkinPick's blog post, "Dermatophagia - What is it?"

Dermatillomania:

Dermatillomania means “Skin Pulling Madness,” and has only been diagnosable since 2013. It is currently classified as an “Obsessive-Compulsive and related disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where it is listed as Excoriation Disorder. However, it is known by many names, such as: Skin Picking Disorder, Compulsive Skin Picking, Acne Excoriée, Pathological Excoriation, Neurotic Excoriation, Pathological Skin Picking, and Psychogenic Excoriation. The many names for this disorder cause interference with its understanding and awareness.

Dermatillomania is often confused with other conditions. Common misdiagnoses result because the picking behavior is a result of a medical condition, confused with OCD, Body Dysmorphic Disorder (BDD) and in some cases, Non-suicidal Self-Injury (NSSI).

PickingMe Foundation - "Picking Me Foundation NFP is the only donor-supported non-profit dedicated to advocating for Dermatillomania (Skin Picking Disorder) sufferers, supporters, and educational communities alike, encouraging individuals to choose themselves over the mental illness that chose them by #PickingMe over Skin-Picking."

Angela Hartlin's Skin Picking Support website. Hartlin is the author of, "FOREVER MARKED: A Dermatillomania Diary" and the creator of the documentary, "Scars of Shame," which you can watch for free here with the password, "Scars1" (Thanks, Angela!)

SkinPick.Com - "SkinPick is the #1 platform to treat excoriation disorder (dermatillomania). Get one-on-one support from a therapist specializing in treating compulsive skin-picking through evidence-based techniques."

SkinPick's "Do I Have Dermatillomania?" Test

SkinPick's blog post. "Skin Picking and Body-Focussed Repetitive Behaviours (BFRB)"

Stuff That Works’ page, “Excoriation (Skin-Picking) Disorder”

Trichotillomania:

Probably the most famous BFRB, Trich has the most resources available thanks to being the first diagnosable BFRB. The resources below are more general as a result:

TrichStop - "TrichStop is the world’s leading platform for Trichotillomania treatment. Get one-on-one support from a therapist specializing in treating compulsive hair pulling through evidence-based techniques." From the same support team behind SkinPick.Com.

TrichStop's "Do I Have Trichotillomania?" Test

TrichStop's blog post, "Trich and Comorbid Disorders: What We Are Learning"

The TLC Foundation's Trichotillomania page.

"Trichotillomania," authored by Aubree D. Pereyra; Abdolreza Saadabadi. Published in StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. (Ongoing)

More to come.

There are more BFRBs than this out there, but I don't have the resources gathered for them yet. Hopefully the General resources help! I'll update this as I have time. In the meantime, I wish you all luck on your BFRB journeys.

-> Anxious? Try This:

[soaps-mohawk]

So I didn't do this my self but my oldest nephew ate hair. He would pull it out of peoples heads, find it in the carpet even pull it off a animal and it's a legit medical condition the name escapes me. We had to duct tape socks on to his hands for a good while and keep all hair tied up too. Changing that kids diapers was a blast.... not

Trichophagia, or at least that's what Google says. My niece went through a hair chewing stage, but it was her own hair. That's wild. Kids do the craziest things. I hope he eventually grew out of it, or got some help to overcome it.

I remember watching videos of people that had an addiction to eating hair and the havoc it would wreak on their stomachs.

[system-of-a-feather]

See as someone who has severe Trichotillomania and moderate other BFRBs, I never saw the point in why they are specified (for me again, cause I am on an extreme end) cause yeah Trichotillomania, Trichophagia, Dermatillomania, yada yada got those but what is

*checks notes*

"Compulsively clipping the calouses on the bottom of my toe with nail clippers to reveal fresh skin"

(I am aware that is not the safest or proper way to remove them, I have Excessive Preening Disorder)

[sadririko]

ɪ ꜰᴇᴇʟɪɴɢ ʟɪᴋᴇ ꜱʜɪᴛ. ʟɪᴋᴇ ᴇᴠᴇʀʏᴛʜɪɴɢ ɪꜱ ᴡʀᴏɴɢ ᴡɪᴛʜ ᴍᴇ. ɪ ᴀᴍ ꜱᴛᴜᴘɪᴅ ᴀɴᴅ ᴜɢʟʏ. ɪ ᴊᴜꜱᴛ ʜᴀᴛᴇ ᴍʏꜱᴇʟꜰ. ɪ ᴀᴍ 27 ʏ.ᴏ ᴀɴᴅ ɪ ᴅɪᴅɴ'ᴛ ᴀᴄʜɪᴇᴠᴇ ᴀɴʏᴛʜɪɴɢ. ᴡʜʏ? ᴡʜʏ? ᴡʜʏ ɪ ɴᴇᴇᴅ ᴛᴏ ꜱᴜꜰꜰᴇʀ? ɪ ᴀᴍ ᴊᴜꜱᴛ ᴀ ʟᴏꜱᴇʀ.