Supporting Your Loved One with a BFRB

Handout from the Pulling Together Conference in May 2016

Amy Jacobsen, Ph.D. & Becky O’Halloran, LMFT

A common reaction when discovering that a loved one is pulling their hair or severely picking their skin may be a combination of fear, distress, frustration and hopelessness. Many parents describe feeling angry – at their child for not stopping the behavior and at themselves for not being able to fix it. There also may be shame – about how the loved one looks and how others are judging them. Here are 10 helpful strategies to support your loved ones (and yourselves!):

  1. Educate yourself about the condition and what evidence-based treatment entails

  2. Stop being the Hair/Skin Police!

    It is rarely helpful to tell individuals to stop pulling or to insist on daily updates – this can actually cause more stress – on both you and your loved one – and give unhelpful attention to the behavior that could exacerbate it

  3. Be loving, supportive, and without pressure or judgment

  4. Remember that these are not life-threatening conditions

    At times, medical intervention is still important, such as with skin infections or indications of hair ingestion

  5. Consider who is more motivated: you or your loved one? – Be aware that your loved one may not be at the same point of readiness as you, and don’t make it more your problem than theirs! Hand it over to your loved one, be there to support them accordingly, and love unconditionally.

  6. Remind yourself that you did not cause this condition in your loved one

  7. Join the TLC Foundation for BFRBs (

  8. Consider joining a group email or forum, such as the, a group email set up by TLC Foundation

  9. Consider setting up an incentive plan with emphasis on rewarding use of new strategies in place of pulling/picking, rather than the absence of pulling/picking

  10. Be patient with slips that will occur and take a problem-solving approach 


The Hair Pulling “Habit” and You: How to Solve the Trichotillomania Puzzle,” Revised Edition by Sherrie Mansfield Vavrichek & Ruth Goldfinger Golomb

“A Parent Guide to Hair Pulling Disorder: Effective parenting strategies for children with Trichotillomania” (Formerly “Stay Out of My Hair”) by Suzanne Mouton-Odum & Ruth Goldfinger Golomb

The TLC Foundation for BFRBs, – an outstanding resource for articles, education, and treatment information

Madison Whiteneck