To an onlooker, it can be confusing;  skin picking and hair pulling appear deliberate.

Doesn’t this mean they are simply choosing to do it? 

If someone’s hands are pulling out their hair or picking their skin, it’s easy to suggest they just stop.

Often people DO stop hair pulling and skin picking and other times they feel that they can’t.  There’s a difference between capacity and choice. Just because you see someone has the capacity to stop in certain situations, doesn’t mean they can make the choice to stop in all situations.  

You probably know that skin picking and hair pulling are body focused repetitive behaviours or BFRBs.  

The behaviours often happen with very little awareness. It is common to  realise the skin is bleeding without remembering making a conscious decision to start picking at it.   At other times, the behaviour may be more focused: the person knows what they are doing but experiences an intense urge that can be extremely difficult to resist.We have all had that feeling when we know something isn’t in our best interests and we still find ourselves drawn to it - but is this the same thing?  Those nights when you know you should stop scrolling and go to sleep are similar, but not the same.  There is a reason that trichotillomania (compulsive hair or eyelash pulling) and dermatillomania (compulsive skin picking) sit alongside OCD in the group of Obsessive Compulsive Disorders.  They can be compulsive and beyond control at times.  It can be scary not to feel safe with your own hands.

Sometimes people make comments which make sense to them in the moment, like “Stop pulling out your hair” or “You’re just doing it for attention.”BFRBs are not usually attention-seeking. In fact, people often go to considerable lengths to hide them. Hair loss is usually disguised and damaged skin covered because of shame, embarrassment and concern about appearances. To stop skin picking is not as simple as deciding not to do it. If it were, most people affected would have stopped long ago.

However, that does not mean BFRBs are a life sentence. People can learn to recognise what the behaviour has served. What has hair pulling given you that human communication cannot?  What aspects of it seem necessary and important for you sometimes? How can you get those in other ways? With experienced and appropriate support, practical strategies and patience, the behaviour can become increasingly manageable.  Many people can stop hair pulling or skin picking and never resume. but most experts would argue that it is helpful to move the goal from stopping permanently to stopping now.Psychology doesn't really support intent as a simple on/off switch. Research on BFRBs itself has struggled with precisely this. The original MIST-A separated hair pulling into automatic (little awareness) and focused (aware, often responding to emotions or urges). But later research found the distinction wasn't so tidy: factors such as awareness, intention and emotional regulation vary.  Some people have more awareness than others and we’d argue that every person’s awareness varies at different times.  Skin-picking and hair pulling research supports automatic and focused dimensions.