Individual therapy

BFRB Therapy: Hair Pulling, Skin Picking & More

Therapy for body-focused repetitive behaviors: hair pulling, skin picking, nail and cheek biting, and related behaviors. You've tried stopping, probably hundreds of times. Willpower was never the missing piece. A plan is.

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50-55 minute sessions Judgment-free, structured work 100% online · TX · ME · MT · NH
Is this you?

It's been helping you cope. You deserve more than coping.

Sometimes you catch yourself mid-episode with no memory of starting. Sometimes you know exactly what you're doing and can't make yourself stop. Either way, what follows is the same: the checking, the covering, the promise that this was the last time. If this sounds familiar:

  • Episodes happen on autopilot: at screens, in mirrors, in bed, in the car, and you only notice afterward
  • Your hands go to the same spots when you're stressed, bored, tired, or deep in concentration
  • You've built a wardrobe and routine around hiding it: hats, makeup, long sleeves, careful angles in photos
  • "Just stop" is the advice you've gotten your whole life, from people who've never had a hand that moves on its own
  • You've quit cold turkey more times than you can count, and every restart felt like proof something's wrong with you
  • The behavior genuinely soothes you in the moment, which makes the shame afterward even more confusing
Understanding the cycle

A pattern that can be interrupted

BFRBs aren't a hygiene issue, a nervous habit, or a discipline problem. They're a regulation strategy that works in the moment and costs too much after. The cycle runs in predictable stages, and naming yours is the first phase of the work.

The BFRB cycle A cycle of five stages connected by arrows in a circle: a trigger such as stress, boredom, or a sensory cue; the urge builds; the behavior, often on autopilot; brief relief, because it genuinely regulates; then shame and hiding, which adds tension and feeds back around. The center is labeled: the pattern, not the person. The pattern, not the person and around again, unless it's interrupted Trigger stress, boredom, a texture The urge builds tension wanting one release The behavior often on autopilot Brief relief it truly soothes, briefly Shame & hiding fuel for the next round

The behavior is doing a job. That's why "just stop" fails: it takes away the regulation without replacing it. The work replaces it first, then interrupts the cycle at every stage.

Who I work with

Every version of a BFRB

Whatever the behavior, however long it's been there, and whoever you've hidden it from. You won't be the first person to say it out loud here.

Hair pulling

Trichotillomania: scalp, brows, lashes, or elsewhere, focused or on autopilot.

Skin picking

Excoriation (dermatillomania): face, cuticles, scalp, or anywhere hands find.

Biting & other BFRBs

Nail biting, cheek and lip biting, and related body-focused behaviors.

Neurodivergent adults

BFRBs alongside ADHD or autism, where sensory needs and regulation are part of the picture.

Decades in

Started in childhood, still here, and never told anyone the whole story.

What we work on

Four fronts, worked in sequence

The plan is built from your specific cycle, because two people with the same behavior can have completely different triggers and functions.

Mapping your triggers

Where, when, and why your episodes actually happen: the emotions, sensations, thoughts, places, and postures involved. Most people have never been asked to look this closely, and the map alone changes things.

Meeting the need differently

Your BFRB is doing a job: soothing, stimulating, or discharging tension. We identify the job precisely, then build other ways to do it, so stopping doesn't mean losing your regulation.

Interrupting the cycle

Practical, evidence-informed tools: awareness training for the autopilot episodes, competing responses for your hands, and changes to the environments and routines where your cycle runs strongest.

Shame, setbacks & repair

Unlearning the "just stop" story and the secrecy it built. Setbacks get treated as data about the cycle, not verdicts about you, because shame is fuel for the very cycle we're interrupting.

How treatment works

A clear, structured plan, built in sequence

This is structured, judgment-free work informed by established BFRB approaches, including the Comprehensive Behavioral (ComB) model and habit reversal training. By session three you'll know your plan, its phases, and roughly how long the work takes. Sessions are 50-55 minutes.

Nothing is demanded on day one: no photos, no show-and-tell, no counting rituals. You share what you choose, when you choose. Progress is measured your way, and the goal is a life where the behavior no longer runs the schedule.

How my methods work →

1

Assessment

Your history, your behaviors, and what's been tried, without judgment.

2

Your cycle map

Your specific triggers, urges, and the job the behavior is doing.

3

Skills phases

Awareness, replacement strategies, and environment changes, in sequence.

4

Consolidation

Making the tools yours, with a real plan for setbacks.

Format

All sessions online via secure, HIPAA-compliant video. You must be physically located in Texas, Maine, Montana, or New Hampshire at the time of session. For many people with BFRBs, joining from home with the camera framed how you choose makes starting easier.

Insurance

Visit the services page to see which insurances are accepted, along with current rates and private pay options.

Approach

Structured, evidence-informed BFRB treatment with a neurodivergence-affirming lens. Full credentials →

Common questions

About BFRB therapy

Quick answers. The full FAQ page has the rest.

They're related but distinct, and the treatment differs. OCD is driven by intrusive thoughts and the rituals that neutralize them; BFRBs are body-focused behaviors that regulate tension, boredom, or sensory needs, often without any thought at all. Some people have both, and the assessment sorts out which is which so the right tools get used.
No, and that framing is part of what keeps people stuck. BFRBs are recognized conditions, not discipline failures. The behavior persists because it works: it genuinely regulates something. Habits that do a job for you don't respond to willpower; they respond to having the job done another way.
I won't promise a number, because honest treatment doesn't. What I can say: most people who do this work see meaningful reduction, far more control over when and where episodes happen, and a dramatic drop in the shame and hiding. For some, that becomes stopping entirely. Setbacks along the way are expected and planned for, not treated as failure.
Important distinction, and it's respected here. Stimming is healthy self-regulation and is never a treatment target; a BFRB is a behavior causing damage or distress you want to change. Many neurodivergent adults have both, and part of the work is separating them, so you keep the regulation that serves you and change only what's hurting you.
No. There are no examinations, no required photos, and no proof of anything. You describe what you choose to describe. One note: therapy isn't medical care, so if picking or pulling has caused wounds, signs of infection, or other physical concerns, it's worth seeing a doctor or dermatologist alongside our work, and there's no shame in that appointment either.
You'll be met with zero shock and zero judgment; BFRBs are far more common than the secrecy around them suggests. The first sessions are just conversation: your history, what the behavior looks like in your life, and what you want to change. You set the pace for what gets shared and when.

Come as you are. Leave with a plan.

The consultation is free and short. We'll talk by phone (I'll call you at the time you schedule) and see if we're a fit. No pressure, no commitment.

Book a free 15-min consultation How therapy works
Free 15-min consultation