15 Do’s and Don’ts for Significant Others of People with Skin Picking or Trichotillomania.

Here is some guidance for significant others of people who pick or pull. It can be challenging to be in a relationship with someone who struggles with skin picking or hair pulling. As a significant other, you want your partner to to be happy and feel good about themselves. It can feel helpless and confusing to watch them engage in the destructive behaviors and suffer emotionally with their inability to stop. Frequently, well intended significant others can accidentally make matters worse in their efforts to help.

First, a bit of education:

Body Focused Repetitive Behavior (BFRB) is an umbrella term that covers a diverse spectrum of problems which seem to be similar in causation and treatment. These include Trichotillomania (Hair Pulling Disorder), Excoriation (Skin Picking Disorder), nail biting, and chewing. BFRBs are genetically-based neurochemical problems that can be very persistent and difficult to get under control.

What Can a Partner Do?

  • Practice self care. Self care is not selfish. When you take good care of yourself, you are able to then be a better partner. It can feel so helpless to watch a loved one suffer. Do things that help revive you, help you feel connected, and centered. This may be seeking your own counseling, reaching out to a good friend, eating well, exercising regularly, and/or daily meditation.
  • Remember your partner is a whole person. They are so much more than just a picker or a puller. Remember all those parts that you fell in love with. It can help to remind them of this too.
  • Be gentle with shame. Many will deny it even when it’s obvious, or lie about how the damage occurred. Confronting them on this may be too overwhelming. Stay with compassion.
  • Create a safe space. Respond to what you see and hear with acceptance and understanding. Let your partner decide who and when to come out to about their disorder. You can be open to discussing it as they are ready. Try to empathize with their emotions.
  • Be sensitive to body image issues. As beautiful as they are in your eyes, they have probably struggled most of their life with appearance. A “flaw” you don’t notice may be consuming their thoughts and flooding their emotions. Your compliment for how she looks now may remind her of the times she didn’t look that way.
  • Refer to a dermatologist if you see signs of infection or irritation. This will not manage the behavior, but will treat the wounds and diagnose underlying conditions. This doesn’t mean it is your job to go looking for damage.
  • Normalize. Everyone picks/pulls at least a little. It is estimated that 1 in 25 do enough damage for it to be considered problematic, likely more. Most think they are the only one. No one is perfect.
  • Encourage treatment. There is no quick fix, BUT there is help. A therapist who has specialized, advanced training on this topic can help clients understand BFRBs and reach a point where they no longer control their life. Be supportive in their recovery activities. Encourage them to persist with treatment even when recovery feels impossible.
  • Recognize that it is not a rational process. No one chooses to have this disorder. The parts of the nervous system that drive the BFRB are not logical. We all have thinking errors and overreact sometimes. Have you ever put something in your mouth that’s not good for you?
  • Allow room for mistakes for both of you. They will have setbacks and struggle deeply with an emotional fall out afterwards. They need your love, acceptance, and patience. You will accidently say something that hurts or angers them, no matter how well intended. Apologize, listen, and reassure, “I love you no matter what.”

What Not to Do?

  • Don’t say “Stop it!” “Don’t pick/pull,” “Quit it.” If it were that simple they would have already stopped. BFRBs are real biological problems and not a rebellion to upset you or signs of weakness.
  • Don’t talk about it loudly where other people may hear about it. Sarcasm, Shaming, embarrassing, and blaming your partner will only make it worse. This is also toxic to your relationship.
  • Don’t take this disorder on as yours to fix. You cannot fix this for them. You cannot motivate them to change. Recovery is possible but it is very difficult- harder than quitting heroine. You can support them on this journey, not nag. Recovery happens only when the person with the disorder takes responsibility for their treatment. Readiness for change happens on their timeline, not yours.
  • Don’t ask too many questions. They probably honestly don’t know the answer to most of your questions, especially “why” questions. Your probing can lead to more frustration and likely more shame and damage. Do collaborate with your partner to establish boundaries about discussion.
  • Don’t be the skin or hair police. This usually backfires on both the behavior and relationship. “Many SOs think that along with having a relationship, they also have a special responsibility to get their loved one to do things that are good for them.  This might include such things as eating properly, exercising, etc.  They believe this concern shows that they are really concerned, and are taking care of the other person.  Unfortunately, when they apply this to their loved one’s BFRB, things can go very wrong.  They may, for instance, take on the role of being the “pulling” or “picking police.”  It usually starts by the SO watching the sufferer like a hawk, and then having to alert them every time they notice them pulling or picking.  They may do this by calling out to them, touching them, making a noise (finger-snapping, throat clearing, etc.), or even throwing things at them (yes, I have actually encountered this).  They may even go well beyond this by grabbing their arm or hand and trying to physically restrain them.  On a different level, some also use sarcasm, guilt, or anger as a way to try to get them to change their behavior. “ – Fred Penzel 

Here is another article with more info for spouses and partners of people with trichotillomania and/or skin picking disorder: http://www.trich.org/treatment/AdviceforSignificantOthers.html

Priscilla Elliott is a Licensed Professional Counselor and Somatic Experiencing Practitioner in south Austin. She owns and provides psychotherapy at Courage Counseling, PLLC. While specializing in helping clients who are struggling with trauma, trichotillomania, and/or skin picking disorder; she also supports many in life transitions, anxiety, and depression. Call now for help: 512-673-3987

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