At this time, there is no comprehensive theory that explains the causes of BFRBs. As it is often the case when it comes to our behaviors, emotions and thoughts, causes are multiple, complex and highly individual. Remember: everyone has their own life story and symptoms arise from that highly specific context. It’s difficult and not always helpful to generalize.

When it comes to mental health, we like to look at causes and consequences from three distinct perspectives: from a biological, psychological and social perspective. Each person will have a different combination of the three. We can see them as partly biological, because grooming behavior is genetic and present in different species, not just in humans. We can see BFRBs as psychological because, like everything else related to our behaviors, they have deep psychological meaning and perform a function in our psychological life. We can see them as social too, because they can bring about rather undesirable social consequences and they play a role in how we’re perceived (and, in turn, how we perceive ourselves). They can be seen as social in part because some research indicates gender disparity (more women than men report struggling with BFRBs) and gender roles tend to be heavily socially regulated. When a man pulls his hair, that has entirely different social meaning than when a woman pulls her hair.

Roughly speaking – and this may not apply to everyone! – we can think of BFRBs as dysfunctional mechanisms of emotional regulation. A commonly reported effect of hair pulling or skin picking is soothing, often followed by shame, guilt or remorse. The self-soothing, however, plays an important role in maintaining BFRBs, as this allows a person to get temporary relief from intense private experiences such as feelings, thoughts or memories.

Shortly put: BFRBs allow you to cope with your emotions without having to feel them fully and process them psychologically.

At the time of writing this article, FDA hasn’t approved a single drug to treat BFRBs, although some are prescribed off-label with varying degrees of success. Even though the number of studies testing different pharmacological treatments for BFRBs are growing, they are still insufficient and usually feature small sample sizes or other methodological limitations that make it difficult to reach definitive conclusions.

Several types of psychotherapy were tested in numerous studies and shown to be effective, most of them belonging to cognitive-behavioral therapies. Habit reversal training, stimulus control, acceptance and commitment therapy all seem to be effective ways of treating BFRBS.

From the available research, it’s possible to say that psychotherapy appears to be a more effective form of treatment.

Keep in mind, however, that psychotherapy is not quick and certainly not easy!