When the causes of body-focused repetitive behaviors (BFRBs), such as hair pulling (trichotillomania), skin picking (excoriation disorder), or nail biting, are discussed, the question often arises: Are these behaviors caused by trauma? It's a fair question. The assumption makes intuitive sense. Many behaviors that cause physical harm or distress are linked to emotional pain or traumatic experiences. However, the science paints a more nuanced picture.
My boyfriend has trichotillomania (he pulls out his beard and mustache hairs when he's anxious or bored without thinking about it). He considers it to be relatively mild because it has never caused any serious physical harm like an infection, and while I've suggested that therapy might help, he thinks that the stress of finding a therapist will just make it worse, but that is an issue for another letter.
