Body-focused repetitive behaviors (BFRBs), such as hair pulling and skin picking, share many characteristics with “classic” addictions, such as gambling, drugs and alcoholism. One common trait is that often, sufferers of BFRBs exhibit strong denial when confronted with their behavior. For skin picking, for example, when asked “Did you pick it?,” a picker will often respond with an adamant “NO!,” even when the evidence is plain to see, much the same way an alcoholic will deny drinking when obviously intoxicated. Almost all of us been unwilling or unable to think objectively, or to simply face the fact that we have BFRBs at some point in our lives. Likewise, as with any addiction, it is all but impossible to help someone who is not ready to face up to the fact that their behavior, be it hair pulling, skin picking, or cheek chewing, as examples, are addictive behaviors indicative of a compulsive condition.

BFRBs are more addictive for some people than others, such as those with the SLITRK1 gene variation which is responsible for poor impulse control (as well as conditions such as Tourette’s syndrome and tic disorders). However, this gene is only present in a small percentage of people with BFRBs, and in those cases NAC (N-acetylcysteine) supplementation may prove beneficial.

B.F. Skinner, America’s leading neobehaviorist and Professor of Psychology at Harvard University from 1958-1974, is known in the field of psychology for his famous experiments with animals, which demonstrated the power of reinforcement (rewards) on behavior. Although Skinner’s reputation is tarnished by accusations of Nazi association, abuse of animals (and possibly his own child), Skinner made numerous discoveries about behavior which help explain why the behavior of hair pullers searching for the perfect root is so addictive.

In perhaps his most famous experiment, Skinner worked with rats in a box. In this experiment, Skinner consistently rewarded rats pressing on a lever to receive a food reward. If the rat pressed a lever the correct number of times, it would be rewarded with the release of a food treat. With different sets of rats, Skinner would vary the experiment by altering the number of times the rat would be required to press on the lever in order to receive its reward – three times, five times, ten times, etc. Interestingly, the rats would learn the correct number of times the lever had to be triggered in order to receive its reward.

KIn perhaps his most famous experiment, Skinner worked with rats in a box. In this experiment, Skinner consistently rewarded rats pressing on a lever to receive a food reward. If the rat pressed a lever the correct number of times, it would be rewarded with the release of a food treat. With different sets of rats, Skinner would vary the experiment by altering the number of times the rat would be required to press on the lever in order to receive its reward – three times, five times, ten times, etc. Interestingly, the rats would learn the correct number of times the lever had to be triggered in order to receive its reward. The rat would work out that if he pressed the lever the particular amount of times, the treat would tumble.

Pressing the lever once produced no reward. Likewise, twice, no reward. Soon the rats learned to press the lever the requisite number or times in quick succession in order to be rewarded. Varying contingencies of demand and reward programmed into the experiment also changed the animals’ response. This led to a much more profound discovery than the apparent fact that small mammals can, if fact, count.

What Skinner did was to begin to vary the schedule and to make the rewards available at random intervals, rather than regularly at a specific number of lever presses. Instead of the expected response of distress and the cessation of the lever-pressing behavior, the reverse was true. The more rare and random the reward, the more the rats would continue to press the lever, trying for the reward, much as a gambler feeding coins into a slot machine in hope and anticipation of a big payday. When the food rewards were released truly at random – rarely – the animal became addicted to the lever-pressing behavior.

This operational conditioning experiment became a breakthrough into what may be behind the addictive behaviors of compulsive gambling, those who continually seek out violent yet randomly “loving” relationships, and offers an insight into why hair pulling “root hunters” hunt on and on for that “perfect” root.

In short, irregularly rewarded behavior is among the hardest to overcome. We search for split ends, for instance, not because every hair has one, but because they are randomly distributed. If each search were rewarded, the joy of searching for and finding the root that is slightly more bulbous – more juicy – would be lessened. It is the surprise, the pleasure or discovery of the random reward, that is the payoff.

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By linking certain behavior such as hair pulling with a situation or feeling, such as “alone time” or relaxation, we condition our brains to associate the behavior with the activity that brings us comfort. That connection is reinforced each time we repeat the behavior in that situation and are rewarded for it. Thus, over time, this repetitive behavior can develop into an addiction.

Any behavior which we perform over and over becomes habitual, and eventually can become addictive. The good news is that almost any behavior, performed repeatedly can therefore become comforting. This becomes problematic, however, because the more often we pull out hair or pick our skin, the more we associate this destructive behavior with self-comfort. Hair pulling is not all about reinforcement – positive or negative. It’s more about excitement – the not knowing whether you are going to be rewarded with that magical juicy root, or have just lost a hair for “no reason.”

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The most conducive conditions for BFRB picking are watching television, reading, or studying, particularly when done alone, during “down time,” which strengthens the association with relaxation in your mind.

Mirrors can be detrimental to people with BFRBs, as they often reinforce body dysmorphic feelings of being unattractive, or simply not looking “right.” Self-scrutiny in mirrors can easily lead to obsession, which is a quick step to addiction. For example, eyelash pulling and skin picking are often caused in part by perfection-seeking behavior, to remove “wonky” eyelashes or to remove a skin spot or blemish, in the desire to have perfect skin or for every eyelash to grow in the direction that is “should.”

As with any addiction, BFRBs are difficult to overcome, and the more we give in to them, the further ingrained the addictive behavior becomes. On the other hand, Neomie Da Costa, who specializes in the online treatment of BFRBs, says that these behaviors do not have to be hard to break, and the things we once thought were so complex and difficult often turn out to be much simpler and easier to overcome that we ever imagined.

To emphasize this, Neomie says that in the same way we create the addiction, with practice we can also undo that addiction. It can be just as easy to condition ourselves with a replacement behavior that is more beneficial to us, and less destructive to our self-esteem. Many of us need help with that, but the good news is that professional, qualified help is available.

We’re seeking stimulation because we are bored – we’re just as bored as if we were kept in a box like a rat with a lever – and root hunting is about stimulation, about reward. Stimulation is rewarding whether it’s positive or negative – if you get the great root, the reward is an adrenaline rush… If you get just a hair, you get the stimulation of a thunk of misery, which can be its own reward. Heads you win, tails you win…

Hairs… You lose!

Online treatment of BFRBs says that they do not have to be hard to break and the things we once thought were so complex and difficult often turn out to be much simpler and easier than we ever imagined.

Help is at hand.

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References: Chamberlain SR, Menzies L, Sahakian BJ, Fineberg NA (April 2007). “Lifting the Veil on Trichotillomania”. Am J Psychiatry 164 (4). 
Zuchner S, Cuccaro ML, Tran-Viet KN, et al. (October 2006). “SLITRK1 mutations in trichotillomania”. Mol. Psychiatry 11 (10):