Beyond Bad Habits: Understanding and Treating Dermatillomania and Trichotillomania

In a recent interview with Dermatology Times, Sofia Wenzler, PhD, a licensed clinical psychologist and specialist in body-focused repetitive behaviors (BFRBs), discussed the challenges and misconceptions surrounding dermatillomania (skin picking disorder) and trichotillomania (hair pulling disorder). Although underrecognized, these conditions are surprisingly common and fall within the spectrum of BFRBs—disorders rooted in self-grooming behaviors that become compulsive and harmful.

Wenzler emphasized that occasional picking or pulling is typical human behavior, with studies suggesting up to 80% of people engage in it occasionally. However, when the behavior becomes repetitive, distressing, and difficult to control, often beginning in childhood or adolescence, it qualifies as a clinical disorder. These behaviors can serve various psychological functions, including emotional regulation or sensory stimulation, and are often accompanied by significant shame and stigma.

One of the most harmful misconceptions, particularly among clinicians and dermatologists, is that BFRBs are simply “bad habits” that can be easily broken. Wenzler underscores that these are recognized psychological disorders, supported by neurobiological evidence and included in both the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) manual. She also notes that treatment is complex and requires specialized care.

In dermatological settings, patients are often told to stop picking before their skin can be treated—advice Wenzler strongly discourages. She notes that skin health and skin care itself can be therapeutic and motivate patients to stay engaged in psychological treatment. Another challenge is that patients rarely disclose these behaviors on their own, making it essential for clinicians to sensitively raise the topic.

Through Helping Minds, Wenzler leads the development of SkinPick and TrichStop, 2 online therapy platforms designed to make BFRB treatment accessible and affordable worldwide. These programs offer structured, personalized therapy sessions supported by expert clinicians, helping to bridge the gap in care for individuals struggling with BFRBs. In addition to direct care, the team promotes education and destigmatization through free webinars, social media posts, and community engagement. Ultimately, Wenzler’s work as the Chief Clinical Officer of each initiative highlights the urgent need for better recognition, compassionate inquiry, and informed care in both psychology and dermatology for those affected by BFRBs.