IMPULSE CONTROL DISORDER

Clients suffering from impulse control disorders experience a strong uncontrollable urge in their body and relieve it by engaging in repetitive body behaviors. One out of 20 people report engaging in repetitive body-focused behaviors including scab picking, nail biting, and knuckle cracking. However, clients with Repetitive Body Focused Disorders (RBFD) report weak control over these urges and behaviors, excessive distress, and significant life interference.

Trichotillomania, or hair pulling, is a very common RBFD. Clients with trichotillomania will pull hair from any site on their body, but the most common sites include eyelashes, eyebrows, scalp hair, underarm and pubic regions, and arm and leg. Individuals with trichotillomania have noticeable gaps or patches in hair growth. Pulling behavior can be focused (with awareness) or automatic (without awareness). The behavior can be experienced as soothing in the moment but can lead to feelings of shame and anxiety. For some people, the pulling ritual includes examination of hair and root, as well as root chewing. Pulling behavior may be triggered by a variety of emotions (e.g., stress, anxiety, anger, boredom), situations (e.g., work, T.V., driving, falling asleep), or contexts (e.g., seclusion, mirrors, grooming).

Skin Picking is an impulse control disorder in which people excessively pick or scratch at their blemishes, scabs/sores, etc. Individuals with skin picking often pick to accelerate the healing of a blemish, achieve symmetry, or soothe an uncomfortable urge. Most individuals will describe feeling out of control or “once I start, I can’t stop.” The damage to skin is often noticeable and leads to embarrassment and shame. As a result, individuals with skin picking will typically attempt to conceal the skin picking sites.