Why You Can't "Just Stop" Picking Your Skin or Pulling Your Hair (And What Actually Works)

If you struggle with skin picking (Excoriation Disorder) or hair pulling (Trichotillomania), you have probably heard the same piece of advice from well-meaning friends, family, or even doctors:

"Why don't you just stop?" You might have even said it to yourself while staring in the mirror after a picking episode, feeling a heavy wave of guilt and frustration. You try snapping a rubber band on your wrist, hiding your tweezers, or making strict promises to yourself that today is the day you will finally quit. But despite your best efforts, your hands always seem to find their way back.

Here is the most important thing you need to hear today: You do not have a willpower problem. Body-Focused Repetitive Behaviors (BFRBs) are not just "bad habits" that you can wish away. Here is why you can't just stop, and what actually works to break the cycle.

The Willpower Myth

When people think of a habit, they think of biting their nails when they are bored or slouching in a chair. But BFRBs are much more complex.

(If you aren't sure if what you are experiencing is a BFRB, check out my previous post: Is it a Habit or a BFRB? Understanding Skin Picking and Hair Pulling).

Telling someone with a BFRB to "just stop" is like telling someone with asthma to "just breathe normally." It completely ignores the underlying neurological drive. Your nervous system is using the picking or pulling to accomplish a specific goal, even if you don't consciously realize it.

Why Does Your Brain Want to Pick or Pull?

To treat a BFRB, we have to understand what the behavior is doing for you. In most cases, picking and pulling act as a coping mechanism for your nervous system. It usually falls into one of two categories:

• To Self-Soothe (Overstimulation): When you are feeling highly anxious, stressed, or overwhelmed, your brain looks for a way to ground itself. The physical sensation of picking or pulling provides a temporary, intense focus that distracts you from emotional distress.

• To Regulate (Understimulation): On the flip side, many people pick or pull when they are bored, tired, or zoning out (like while watching TV or driving). In these moments, the brain uses the behavior to create stimulation and keep you alert.

Often, people describe falling into a "trance" while picking or pulling. The behavior literally changes your brain chemistry in the moment, providing a brief sense of relief or satisfaction. That is why willpower alone will never be enough to stop it - your brain is getting a reward.

What Actually Works: HRT and the ComB Model

If willpower doesn't work, what does? To successfully treat BFRBs, we use specialized, evidence-based behavioral therapies. The two most effective approaches are Habit Reversal Training (HRT) and the Comprehensive Behavioral (ComB) model.

Instead of just telling you to stop, we work together to build a highly personalized toolkit. Here is what that looks like:

1. Building Awareness

You cannot change a behavior you don't know is happening. Because picking and pulling are often unconscious, our first step is tracking when, where, and why your hands move. We figure out your specific triggers (like the bathroom mirror, driving, or feeling stressed after work).

2. Modifying Your Environment

We make the behavior harder to do. This might mean changing the lighting in your bathroom, covering mirrors, keeping your hair tied back, or using barriers like band-aids or specific types of gloves during your highest-risk times.

3. Creating Competing Responses

Since your nervous system is looking for a specific sensation, we have to give it a healthier alternative. If you pull your hair when you are stressed, we find a different physical action that occupies your hands and provides a similar physical release (like using a specific fidget tool or practicing a grounding technique) exactly when the urge hits.

You Don't Have to Carry the Shame

BFRBs thrive in isolation. The shame of having visible bald spots, scars, or scabs often keeps people from reaching out for help. But you do not have to fight your nervous system alone, and there is absolutely nothing to be ashamed of.

If you are an adult in Calgary, Edmonton, or anywhere in Alberta, and are ready to learn the tools to manage your skin picking or hair pulling, I am here to help.

As a psychologist who treats BFRBs and anxiety disorders, I offer virtual therapy across Alberta to help you get your hands - and your life - back under your control.

Click here to book your first appointment.