The above conditions are also known as body focused repetitive behaviors (BFRBs).
Individuals with these problems often feel embarrassed, frustrated, and discouraged.
Body Focused Repetitive Behaviors (BFRBs) include:
- Skin-picking (dermatotillomania)
- Hair-pulling (trichotillomania)
- Nail-biting (Onychophagia)
Sometimes these behaviors are due to:
- A habit disorder that may be unconscious
- Obsessive compulsive behavior
- Reaction to stress
- Sometimes they can be a combination of all 3 of the above, even in the same patient, at different times.
Also, these patients frequently have other obsessive-compulsive behaviors, and/or even obsessive-compulsive disorder (OCD).
For people with BFRBs, I utilize a combination of medical hypnosis, cognitive behavioral therapy, and powerful motivational tools. Hypnosis is unique as it can create a different kind of automaticity in response to the urge the patient often feels.
Many therapists will use exposure and response prevention (ERP), and although that may be helpful, it often is not enough for this problem, depending on what is causing it. Plus, ERP can take a very long time to work. And it requires a lot of time and effort on the part of the patient.
N-acetyl cysteine (NAC) has been used to treat patients with BFRBs.
The results have never been consistently great for NAC for these conditions, with the exception perhaps of one larger study in which 56% of patients improved with NAC compared to 16% who took placebo.
Most other studies were small case reports.
I believe it gets down to how you view the problem.
My concern is that by suggesting NAC, it turns the picking/pulling/biting into a “chemical imbalance.” This allows patients to feel somewhat helpless and that they have no control over it.
Like many problems, it’s understandable for people to want “the quick fix, the pill.”
And it’s harder for them to do the work required by using medical hypnosis and CBT.
The problem is, if they take NAC and get better, they don’t really know if it’s from the NAC vs. the placebo effect.
I prefer for patients to do the work on their own. Rather than taking medicine to control the problem, when they improve, they can say, “I did this on my own!”. This allows them to feel empowered. And it also increases their self-confidence and self-esteem.
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