Do you work with partners and family for BFRBs?

Yes. Loved ones often add pressure or policing without meaning to, which makes BFRBs worse. Sessions can include the people around you when that serves your goals.

BFRB Therapy

BFRB Therapy for Neurodivergent Adults

Affirming support for hair pulling, skin picking, nail biting, and other body-focused repetitive behaviors, treated as nervous-system regulation rather than bad habits to break. Online across Texas, Maine, New Hampshire, and Montana.

BFRB stands for body-focused repetitive behavior, an umbrella term for behaviors like hair pulling (trichotillomania), skin picking (dermatillomania), and nail biting, where a hand-to-body action provides sensory or emotional regulation.

Licensed in TX, ME, NH & MT ComB · HRT · ACT trained 100% online, from home Free 15-minute phone consult

If you have been told to just stop, and just stopping has never once worked, you are in the right place.

Book a Free 15-Min Phone Consult

If you pull, pick, bite, or scratch, and you have spent years cycling through shame, hiding, and resolutions that collapse, I want you to know something first: body-focused repetitive behaviors are not bad habits or weak willpower. They are what a nervous system reaches for when it needs to regulate, and they are very common in neurodivergent adults. My work treats the behavior as information about your system, never as evidence of a flaw, and I would be glad to help.

BFRBs this page covers

Hair pulling, also called trichotillomania, from the scalp, brows, lashes, or body
Skin picking, also called dermatillomania or excoriation, of skin, scabs, or blemishes
Nail biting and cuticle picking, also called onychophagia
Cheek, lip, and inner-mouth biting
Other body-focused repetitive behaviors that soothe, stimulate, or discharge tension
BFRBs alongside autism, ADHD, AuDHD, anxiety, OCD, or sensory differences

An honest note about fit, before anything else

I am a therapist, all of my sessions are virtual, and this is outpatient care: typically one 50-minute session a week. That is the right level of support for most people living with BFRBs, and not enough for some, and naming the difference up front is part of respecting you.

This level of care fits when

Any wounds or skin or scalp damage are healing and being followed by a doctor if needed
Weekly support is enough to work on triggers, urges, shame, and daily patterns
You want change at your own pace, from your own home

More support fits better when

Picking or pulling has caused wounds needing close medical or dermatological care
The behavior is tied to thoughts of self-harm or a mental health crisis
You or your providers feel a higher level of care would help right now

If you are in the second column, that is information, not failure. Higher levels of care and specialized programs exist, and the TLC Foundation for BFRBs (bfrb.org) keeps a therapist and resource directory for finding them. You are welcome here for outpatient work whenever that becomes the right level again.

What BFRBs Really Are

BFRBs are self-grooming behaviors that have intensified past their original purpose: the hand goes to the hair, the skin, the nails, and finds something regulating there, focus, relief, stimulation, or a discharge of tension. For neurodivergent adults especially, they often work as a sensory and emotional regulation tool, which is exactly why willpower fails against them. You are not fighting a habit. You are removing a coping strategy your nervous system relies on, which never works until something is offered in its place.

If you want to go deeper on the neurodivergent angle, the posts below on BFRBs in neurodivergent adults and supporting a partner with BFRBs are good starting points. You do not need a diagnosis to begin.

How I work

The non-negotiables No shaming, no willpower lectures, and no treating your hands as the enemy. We work with your nervous system, not against it, and you set the goals. Consent and your own pace are the floor of every session.

BFRB work has a real evidence base, and I draw on the three approaches that fit it best. The Comprehensive Behavioral (ComB) model maps the specific sensory, cognitive, emotional, and environmental drivers behind your behavior, so we understand your pattern precisely. Habit Reversal Training builds awareness of urges and offers competing responses that meet the same need more safely. And Acceptance and Commitment Therapy adds the affirming layer: reducing the shame and self-attack that keep the cycle spinning, while you move toward what matters to you. For a neurodivergent nervous system, that combination respects the regulation the behavior provides instead of trying to rip it away.

What we can work on

Understanding your pattern

Mapping the real drivers, sensory, emotional, situational, behind when and where the behavior shows up.

Awareness and competing responses

Catching urges earlier and meeting the same need with something that asks less of you.

The shame layer

Unwinding years of hiding, self-blame, and the secrecy that keeps the cycle going.

Sensory regulation

Building a toolkit of inputs that satisfy what your nervous system is reaching for.

Triggers and environments

Adjusting the settings, the mirror, the desk, the wind-down hour, where the behavior thrives.

Self-acceptance, not just reduction

Living well and treating yourself kindly, whatever the behavior is doing on a given week.

Not sure where your pattern even comes from? That is exactly what the first sessions are for.

Start With a Free 15-Minute Phone Consult

What working together looks like

A free 15-minute phone consult, zero pressure

A short phone call. You share whatever feels comfortable, ask anything on this page or off it, and see how the fit feels. No preparation needed, no commitment, and nothing is decided on the call unless you want it to be.

A first session that maps, never shames

We go at your pace through your history with the behavior, when and where it shows up, and what you want from this. Every question is optional, and there is no inspection of your skin or scalp, no checking, no judgment. The goal of session one is that you leave feeling understood.

You will know where the session is headed before it heads there. No surprises.

Ongoing sessions, shaped by your goals

Weekly or every other week, 50 minutes, online. We map your drivers, build awareness and competing responses, lower the shame, and adjust as life shifts. Progress is not a straight line with BFRBs, and that is expected, not a failure. You can change goals, slow down, or pause anytime.

Ready when you are: book the free consult and start at step one.

Practical details

There are two ways to work together, and we can sort out exactly which applies to you at the free consult:

Using insurance

Select insurance plans are accepted. Bring your plan details to the consult and we will confirm whether yours is one of them.

Private pay

Sessions are $200, and if I am not in network with your provider, superbills are available for out-of-network reimbursement if your plan offers it.

Sessions are 50 minutes, held by secure, HIPAA-compliant video, with evening and weekend appointments available. Everything happens from wherever you are most comfortable: your sofa, your favorite chair, your safest room.

Online sessions, from your safest space

Every session is online, which suits BFRB work well: you join from your own home, with no waiting rooms and no feeling watched, which matters when the topic is something you have spent years hiding. If you are new to teletherapy, here is how online therapy works. I am Amiti Grozdon, M.Ed., LPC, a licensed professional counselor working with autistic, ADHD, and AuDHD adults, and I see clients across Texas, Maine, New Hampshire, and Montana.

BFRB therapy in Texas

Online sessions for adults across Texas: Austin, Houston, Dallas, Fort Worth, San Antonio, El Paso, and the many towns where a BFRB-informed, neurodivergent-affirming therapist is hard to find locally.

More about therapy in Texas →

BFRB therapy in Maine

Serving adults throughout Maine, from Portland and Lewiston to Bangor, Augusta, and the coastal and rural towns where specialized BFRB support rarely exists nearby. No driving required.

More about therapy in Maine →

BFRB therapy in New Hampshire

Online sessions statewide: Manchester, Nashua, Concord, Portsmouth, the Seacoast, and the North Country. Many New Hampshire adults find no local BFRB-fluent options at all. This is built to be one.

More about therapy in New Hampshire →

BFRB therapy in Montana

Serving adults across Montana: Billings, Missoula, Bozeman, Helena, Great Falls, and the towns where the nearest specialist is a long drive away. Online therapy closes that distance.

More about therapy in Montana →

Where would you be joining from?

All sessions are online. Tap your state to see if we can work together.

Amiti Grozdon

M.Ed., LPC, LCMHC, LCPC · TX LPC #92348 · NH LCMHC #5711 · ME LCPC #8561 · MT LCPC #87815

I work with autistic, ADHD, and AuDHD adults, including many who have carried a BFRB in secret for years. More about me and my approach. My training spans AANE neurodiverse couples work, ACT for autism and adult ADHD, and DBT for neurodivergent clients, and my approach to BFRBs draws on the ComB model, Habit Reversal Training, and ACT. Your nervous system is not the problem, and therapy should feel like the most accommodating room you have ever been in.

Built to be autism-friendly

Fidget tools, stim toys, and moving around are welcome, always
Join from your most comfortable spot: sofa, floor, blanket nest, all fine
Pauses are built in: ask for a breather any time, no explanation needed
Cameras stay on during sessions, because this work is done together, and you choose everything else about your setup
No surprise topics: you will know where a session is headed
Scripts, notes, and prepared text are great ways to communicate here
Direct questions get direct answers, with no decoding required
Processing time is normal: silence is fine, and so is answering next week

Questions people ask before reaching out

Are BFRBs just bad habits or a lack of willpower?

No. BFRBs are nervous-system regulation behaviors, which is exactly why willpower fails against them. They tend to soothe, focus, or discharge tension, and removing them only works when something is offered to meet the same need. The behavior is information, not a character flaw.

Why are BFRBs so common in neurodivergent people?

Autistic and ADHD nervous systems often seek extra sensory input and regulation, and BFRBs can become one way to get it. They also rise with the stress, masking, and overload that neurodivergent adults carry. BFRBs frequently sit alongside autism and ADHD, and they are often best addressed as part of that fuller picture. Treating them well means respecting the regulation they provide, not shaming it.

Will you make me stop cold turkey?

No. Forcing a sudden stop removes a coping tool with nothing in its place, which tends to backfire. The work builds awareness, competing responses, and sensory alternatives at your pace, while lowering the shame that keeps the cycle going.

Do I have to show you my skin or scalp?

Never. There is no inspection, no checking, and no judgment of how things look. This is talk therapy about your patterns, your triggers, and what helps. What you share is entirely your choice.

What approaches do you use for BFRBs?

Three that fit BFRBs well: the Comprehensive Behavioral (ComB) model to map your specific drivers, Habit Reversal Training to build awareness and competing responses, and Acceptance and Commitment Therapy to reduce shame and reconnect you with what matters. All delivered through a neurodivergent-affirming lens.

Do you work with partners and family too?

Yes. Loved ones often want to help and accidentally add pressure or policing, which makes BFRBs worse. Sessions can include the people around you, and the post on supporting a partner with BFRBs is a good thing to send them today.

Do you offer BFRB therapy in Texas?

Yes. I hold a Texas LPC license (#92348) and see adults online across the state, from Austin, Houston, Dallas, and San Antonio to rural towns far from any specialist.

Do you offer BFRB therapy in Maine?

Yes. I am licensed in Maine (LCPC #8561) and work with adults statewide, including Portland, Bangor, Lewiston, and Augusta, all online.

Do you offer BFRB therapy in New Hampshire?

Yes. I am licensed in New Hampshire (LCMHC #5711) and see adults online throughout the state: Manchester, Nashua, Concord, Portsmouth, and beyond.

Do you offer BFRB therapy in Montana?

Yes. I am licensed in Montana (LCPC #87815) and work with adults online across the state, including Billings, Missoula, Bozeman, Helena, and Great Falls.

How do we start?

A free 15-minute phone consult: you share whatever feels comfortable, ask anything, and see how the fit feels. No commitment, no pressure, and nothing you do not initiate.

Related support at Sagebrush

BFRBs rarely travel alone. If yours are one thread of a bigger picture, these are the adjacent rooms:

Therapy for Neurodivergent Adults Autism Therapy for Adults ADHD Therapy ARFID Therapy How Online Therapy Works About Amiti FAQs Book a Free Phone Consult