The Underdog of OCD-Related Concerns Just Got Trich-ier: Bodily Focused Repetitive Behaviors During the COVID 19 Pandemic

The Underdog of OCD-Related Concerns Just Got Trich-ier: Bodily Focused Repetitive Behaviors During the COVID 19 Pandemic

Mandy Simmons, MA, PsyD

Mandy Simmons, MA, PsyD

Mandy Simmons (she/they) earned their doctorate in Clinical Psychology from the Graduate School of Professional Psychology at the University of Denver with a specialty focus in behavior analysis and psychological assessment. Dr. Simmons has extensive experience treating anxiety, OCD, and related disorders with a specialization in treating bodily-focused repetitive behaviors.  They completed their internship at the Mental Health Center of Denver on the Child and Family Track with an emphasis on working with the LGBTQIA+ community and emerging adults and are completing their postdoctoral fellowship at the Center for Anxiety and Behavioral Change in Rockville, Maryland. Dr. Simmons is passionate about providing multiculturally-responsive care to children, teens, and their families. 

Rachel Singer, PhD

Rachel Singer

Rachel Singer, PhD (she/her) is one of the Clinical Directors at Resnik and Associates. She is a licensed psychologist who specializes in providing evidence-based clinical interventions for children, adolescents, adults, and families. Dr. Singer earned her Ph.D. in Counseling Psychology from Boston College. She completed a two-year Postdoctoral Fellowship in the Kennedy Krieger Institute at Johns Hopkins School of Medicine. In addition to her clinical background and training, Dr. Singer also regularly presents at national conferences, publishes research in peer-reviewed journals, and writes academic book chapters on a variety of subjects. Dr. Singer was awarded the American Psychological Association’s Citizen Psychologist Award for her outreach work with immigrant, refugee, and asylee communities.

The Underdog of OCD-Related Concerns Just Got Trich-ier: Bodily Focused Repetitive Behaviors During the COVID 19 Pandemic

Share
No
Bodily Focused Repetitive Behaviors

Dr. Google is often the first stop for most individuals with bodily-focused repetitive behaviors (BFRBs) such as skin-picking (excoriation disorder) and hair-pulling (trichotillomania). Trying to understand these behaviors often leads to self-research when other treatments fail. Too often, clients tell me they have been told “why don’t you just stop?” or “it’s just a bad habit.” Fortunately, in recent years, fantastic organizations like The TLC Foundation (bfrb.org) and independent researchers and clinicians have increased the visibility of BFRBs. 

Somewhere between one and five percent of the population meets criteria for BFRB diagnosis with the majority of the individuals assigned female at birth (American Psychiatric Association, 2013; Hayes, Storch & Berlanga, 2009). It is likely prevalence rates are even higher given the impact of stigma on self-reporting of symptoms. While most folks struggling with BFRBs have a history since pre-adolescence, many do not enter treatment until the consequences of the BFRB have reached a critical stage (or until their loved ones fear they have). Fundamentally, BFRBs typically result in relief or satisfaction of an urge. While the behaviors themselves are not typically unpleasant for the individual, the consequences of BFRB (e.g. judgment from others, scarring, baldness, infection, etc.) are often very distressing. Like many other challenges, added pressures associated with the COVID-19 global pandemic have only increased concerns and symptoms for individuals struggling with BFRBs. 

Reduced in-person interaction and the shift to a virtual environment have provided the opportunity to turn off cameras and remain unseen while still, ostensibly, participating. The presence of others can sometimes deter BFRBs, so solitary activities may increase symptoms. In addition to the increased ability to pick or pull “in peace,” some individuals are finding it harder to resist the urge of BFRB due to boredom from consistently lower levels of stimulation, social and otherwise. Boredom, sleepiness, and anxiety are often triggers for increased vulnerability to BFRBs for those who are already struggling. Many folks whose BFRB symptoms increased due to lack of social oversight may now be experiencing increased shame and fear of social judgment for the consequences of BFRB as they return to in-person activities. Folks are experiencing increased anxiety and shame in addition to an increased history of engaging with the BFRB rather than resisting the urge when it shows up. Past behavior predicts future behavior, and the difficulty of engaging in an alternative to the BFRB increases. 

Fortunately, there are very effective evidence-based treatment options for reducing BFRB symptoms. While there is mixed evidence about medication for treating BFRBs (Mansueto, Goldfinger Golomb, McCombs Thomas, & Townsley Stemberger, 1999), there are multiple evidence-based, behaviorally-oriented treatments available. These include: cognitive behavioral therapy, which typically emphasizes habit reversal training (HRT; Azrin, Nunn & Frantz, 1980) and the comprehensive model (ComB; Mansueto, Goldfinger Golomb, McCombs Thomas, & Townsley Stemberger, 1999), acceptance and commitment therapy (Woods & Twohig, 2008), and dialectical behavioral therapy (Keuthen et al., 2010).  

If you or someone you know is struggling with a BFRB, here are a few strategies to try on your own, keeping in mind each BFRB is unique:

  1. Increase awareness by tracking your urges and BFRB episodes (e.g. phone applications like SkinPick and TrichStop, creating your own Excel spreadsheet).
  2. Look for patterns and block triggers (e.g. wear gloves, put tape or Band Aids on fingers, cover mirrors, etc.).
  3. Identify appealing alternative behaviors (e.g. peeling tape or stickers off a fidget object, toying with the fibers of a paintbrush, squeezing a fist or keeping your hand in your pocket).

If someone you know has a BFRB, one of the most important things you can do is learn about BFRB and express understanding that the BFRB is serving a purpose, whether it is self-stimulation, soothing anxiety, relief of perceived flaws, some combination of these, or something else. Rather than shaming your loved one for their repetitive behavior, respond with openness and curiosity. This will support their willingness to engage in treatment. If you are struggling with a BFRB, know that you are not alone; there are support groups available and practitioners ready and excited to work with you. 
 

Mandy Simmons, MA, PsyD

Mandy Simmons, MA, PsyD

Mandy Simmons (she/they) earned their doctorate in Clinical Psychology from the Graduate School of Professional Psychology at the University of Denver with a specialty focus in behavior analysis and psychological assessment. Dr. Simmons has extensive experience treating anxiety, OCD, and related disorders with a specialization in treating bodily-focused repetitive behaviors.  They completed their internship at the Mental Health Center of Denver on the Child and Family Track with an emphasis on working with the LGBTQIA+ community and emerging adults and are completing their postdoctoral fellowship at the Center for Anxiety and Behavioral Change in Rockville, Maryland. Dr. Simmons is passionate about providing multiculturally-responsive care to children, teens, and their families. 

Rachel Singer, PhD

Rachel Singer

Rachel Singer, PhD (she/her) is one of the Clinical Directors at Resnik and Associates. She is a licensed psychologist who specializes in providing evidence-based clinical interventions for children, adolescents, adults, and families. Dr. Singer earned her Ph.D. in Counseling Psychology from Boston College. She completed a two-year Postdoctoral Fellowship in the Kennedy Krieger Institute at Johns Hopkins School of Medicine. In addition to her clinical background and training, Dr. Singer also regularly presents at national conferences, publishes research in peer-reviewed journals, and writes academic book chapters on a variety of subjects. Dr. Singer was awarded the American Psychological Association’s Citizen Psychologist Award for her outreach work with immigrant, refugee, and asylee communities.

Use of Website Blog Commenting

ADAA Blog Content and Blog Comments Policy

ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors – or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees. Any comments or opinions expressed are those of their respective contributors only. Please remember that the open and real-time nature of the comments posted to these venues makes it is impossible for ADAA to confirm the validity of any content posted, and though we reserve the right to review and edit or delete any such comment, we do not guarantee that we will monitor or review it. As such, we are not responsible for any messages posted or the consequences of following any advice offered within such posts. If you find any posts in these posts/comments to be offensive, inaccurate or objectionable, please contact us via email at [email protected] and reference the relevant content. If we determine that removal of a post or posts is necessary, we will make reasonable efforts to do so in a timely manner.

ADAA expressly disclaims responsibility for and liabilities resulting from, any information or communications from and between users of ADAA’s blog post commenting features. Users acknowledge and agree that they may be individually liable for anything they communicate using ADAA’s blogs, including but not limited to defamatory, discriminatory, false or unauthorized information. Users are cautioned that they are responsible for complying with the requirements of applicable copyright and trademark laws and regulations. By submitting a response, comment or content, you agree that such submission is non-confidential for all purposes. Any submission to this Website will be deemed and remain the property of ADAA.

The ADAA blogs are forums for individuals to share their opinions, experiences and thoughts related to mental illness. ADAA wants to ensure the integrity of this service and therefore, use of this service is limited to participants who agree to adhere to the following guidelines:

1. Refrain from transmitting any message, information, data, or text that is unlawful, threatening, abusive, harassing, defamatory, vulgar, obscene, that may be invasive of another 's privacy, hateful, or bashing communications - especially those aimed at gender, race, color, sexual orientation, national origin, religious views or disability.

Please note that there is a review process whereby all comments posted to blog posts and webinars are reviewed by ADAA staff to determine appropriateness before comments are posted. ADAA reserves the right to remove or edit a post containing offensive material as defined by ADAA.

ADAA reserves the right to remove or edit posts that contain explicit, obscene, offensive, or vulgar language. Similarly, posts that contain any graphic files will be removed immediately upon notice.

2. Refrain from posting or transmitting any unsolicited, promotional materials, "junk mail," "spam," "chain mail," "pyramid schemes" or any other form of solicitation. ADAA reserves the right to delete these posts immediately upon notice.

3. ADAA invites and encourages a healthy exchange of opinions. If you disagree with a participant 's post or opinion and wish to challenge it, do so with respect. The real objective of the ADAA blog post commenting function is to promote discussion and understanding, not to convince others that your opinion is "right." Name calling, insults, and personal attacks are not appropriate and will not be tolerated. ADAA will remove these posts immediately upon notice.

4. ADAA promotes privacy and encourages participants to keep personal information such as address and telephone number from being posted. Similarly, do not ask for personal information from other participants. Any comments that ask for telephone, address, e-mail, surveys and research studies will not be approved for posting.

5. Participants should be aware that the opinions, beliefs and statements on blog posts do not necessarily represent the opinions and beliefs of ADAA. Participants also agree that ADAA is not to be held liable for any loss or injury caused, in whole or in part, by sponsorship of blog post commenting. Participants also agree that ADAA reserves the right to report any suspicions of harm to self or others as evidenced by participant posts.

RESOURCES AND NEWS
Evidence-based Tips & Strategies from our Member Experts
RELATED ARTICLES
Block reference