The Tricky SCAMP of Overcoming Skin Picking and Hair Pulling
Body Focused Repetitive Behavior
Do you pick at your skin or have obsessive nail biting habits? Do you pull out your hair without awareness? If so, you may be struggling with a body-focused repetitive behavior (BFRB) such as trichotillomania (hair pulling disorder) or excoriation disorder (compulsive skin picking). These mental health concerns are categorized with obsessive-compulsive and related disorders such as obsessive compulsive disorder (OCD) and body dysmorphic disorder. To learn more about BFRBs, head over to my blog post on Why am I damaging my hair, skin, & nails when I am stressed? or to learn how to cope with your BFRB during the winter, check out this blog post, Thriving in Winter with Body-focused Repetitive Behaviors.
What does therapy look like?
What does treatment for a hair pulling or skin picking disorder look like? Well one treatment option starts with getting to know the sensory, cognitive, affective, motor, and place of your BFRB; this is known as SCAMP. The SCAMP is a central part of the comprehensive model for behavioral treatment (ComB) developed by Charles S. Mansueto, PhD, Sherrie Mansfield Vavrichek, LCSW-C, Ruth Goldfinger Golomb, LCPC, which is a mixture of cognitive behavioral therapy and behavioral therapy that helps individuals manage their impulsive behavior. This model helps therapists and clients work together to understand the repetitive behaviors of the BFRBs they want to change. Next is to develop an individualized plan to implement new coping skills to reduce their skin picking or hair pulling behaviors.
Am I ready for treatment?
Before we get into some of the specifics of this treatment, first reflect on how you feel about wanting to change your body-focused repetitive behavior. There is a good chance your BFRB is doing something for you and change means learning how to give up the BFRB behaviors for other ways of reaching your needs. Change takes effort. Staying where we are takes effort as well, but it is effort that feels more familiar and predictable. To be effective, treatment takes a willingness to try new things, have a curiosity about yourself, and practice, practice, practice!
After some reflecting and deciding that you are up for the challenge, then the next step is observing ourselves. Like scientists, we need to gather some data on the behaviors we want to change.
Then we can use that data to create individualized skills.
Exploring our compulsive behavior through SCAMP
So let’s get to the SCAMP of the ComB treatment model. Here in the SCAMP, data about your body-focused repetitive behavior is collected in 5 main domains, sensory, cognitive, affective, motor, and place; thus creating the acronym SCAMP. The following are some questions to help you begin your investigation into your repetitive biting, compulsive skin picking, or hair pulling:
1. Sensory: Where do you tend to pull or pick? Are there particular spots on your body? Some individuals will only pick out their pubic hair, others their eyebrows or eyelashes. Some individuals only pick skin from their lips, some from their nails, others may bite/ chew their lips or cheeks. Of course, you can have a mixture of these behaviors. What are the physical sensations or sensory stimulation you get right before, during, and after you pull your hair or pick your skin? What is the sensation you are seeking when you go searching for the hair, eyelash, or piece of skin? After you have extracted the hair or piece of skin, do you do anything with it? Maybe you examine it, play with it, chew it, or eat it.
WARNING: If you are ingesting your hair, you should let your doctor know as a buildup of hair could cause an intestinal blockage called a trichobezoar. You can find out more information on this concern, here.Clara Kuntz, Ph.D.
2. Cognitive: What thoughts do you have right before, during, or after you engage in your BFRB? Do you have beliefs about your BFRB? Do you think, “If I could just get this one rough patch of skin smooth or pull that coarse hair, I’ll stop”?
3. Affective: What emotions do you feel before, during, and after you pick or pull? Were you anxious, bored, tired, hungry, sad, hopeless, panicked, shamed, embarrassed, or something else? As humans, we experience a plethora of emotions. Learning to label and describe our emotions can help us understand them better. This can be difficult at first, but with some practice and curiosity, we can start to form ways to communicate our emotions as well as what we need when they show up.
4. Motor: What is your physical stance or posture before, during, and after you engage in your BFRB? Are you standing, sitting, or laying down? Are your hands at your sides, crossed, in your lap, or propped near your face or head?
5. Place: Described the environment where you are when you pick or pull. Are you in the bathroom, living room, your car, or your bed? Are there other people around and if so who? Do you only pick when people are not around? What time of day is it? Do you use any tools during your BFRB, such as tweezers?
Trying something new through creativity
Now that you know your BFRB more intimately, you can start to develop substitutes or blockers to replace or fulfill the need your BFRB is providing. This is the step that involves an openness to trying new things.
For each domain of SCAMP that you collected data on, you will try to think of a healthy substitute or alternative. For example, if you tend to pluck your eyelashes well you read or study and wear contacts; you could try switching into your glasses before you start studying or reading. If you do not need prescription glasses, you could keep a set of none prescription or blue light blocking glasses near your book or tablet to try wearing. The glass on the frame close to your eyes will be a deterrent. This will make access to your eyelashes less accessible.
You may also need to change where you are sitting or how long you read. Studying can increase stress or boredom; which can both be a trigger to picking or pulling in a BFRB.
Did you notice how specific this intervention was?
Interventions can take into account many aspects of SCAMP; where are you, how are you feeling, what sensations are you seeking, what motor movements are you doing, etc. You may need to develop a few different interventions, try them out for a week and see if they need adjusting or changing. It is very important to keep track of the interventions you try, this way you will know if they worked or if they need modifying.
Support and resources for a body focused repetitive behavior
This model takes action, organization, and record keeping. It may be helpful to use a guide, such as the book Overcoming Body-Focused Repetitive Behaviors: A Comprehensive Behavioral Treatment for Hair Pulling and Skin Picking. Also, another resource is the TLC Foundation for Body-focused Repetitive Behaviors website
These self-help resources are not a substitute for therapy, therefore it can be important to consider if help from a therapist may be beneficial. This can especially be important if we are struggling with an anxiety disorder, mood disorder, and other mental health concerns that may be making our BFRBs worse or even harder to cope with. If you or a loved one living in NYS are struggling to manage a BRFB and are interested in starting psychotherapy, please feel free to contact me for a free consultation. If you are outside NYS, a great place to start searching for a therapist is on this website site https://www.bfrb.org/find-help-support/find-a-therapist.
Clara Kuntz, Ph.D., psychologist, is honored to help her clients explore their individual lived experiences. Doctor Kuntz enjoys working with and writing about body-focused repetitive behaviors. She underwent clinical training in CBT-Based Treatment for Trichotillomania & Skin Picking Disorder through the TLC Foundation for Body-Focused Repetitive Behaviors. Doctor Kuntz also has a passion for working with college students, young professionals, and individuals working through challenging careers and life transitions. If you have questions or if you are seeking assistance, Dr. Kuntz can be reached at 716.300.6304 | firstname.lastname@example.org