Skin Picking and Hair Pulling: When You Have Both

If you pull your hair and also pick at your skin, you’re far from the only one. Skin picking and hair pulling are close relatives, and many people live with both. Having two doesn’t mean you’re doing twice as badly. It usually means the same urges are showing up in two places.

This guide covers how common it is to have both, why they overlap, what helps with both at once, and where to find support. Skin picking is also called dermatillomania or excoriation disorder.

How common is having both skin picking and hair pulling?

Having both is common. In a 2024 US study of 378 adults with hair pulling disorder, skin picking disorder or both, 96 people had both. That means nearly half of those who pulled also picked, and about a third of those who picked also pulled.

These were people who came forward for research, so the numbers may not match everyone who picks or pulls, and no large population study has measured it. But the research agrees the two often go together. A 2012 online study found that people with skin picking disorder had other repetitive behaviours far more often than students without it, and that when people had more than one, they tended to involve the same part of the body.

What are skin picking and hair pulling?

Both are body-focused repetitive behaviours (BFRBs): conditions where you repeatedly pull, pick or bite at your own hair, skin or nails and find it very hard to stop. In skin picking disorder, you pick, scratch or squeeze at spots, scabs or rough patches until the skin is damaged. In trichotillomania, you pull out hair from your scalp, brows, lashes or elsewhere. Neither is a bad habit or a lack of willpower. You can read more in our guide to body-focused repetitive behaviours. There’s more on hair pulling in our complete guide to trichotillomania.

Why do picking and pulling so often go together?

They run on the same loop. Something sets off an urge, such as a feeling, a sensation, a time of day or a place. Picking or pulling eases the urge and brings a moment of relief or satisfaction. Then the relief fades, often into frustration or shame, and the loop starts again.

Both are often driven by stress, boredom, tiredness, and hunting for something that feels “wrong”, whether a coarse hair or a rough bit of skin. Both can happen on autopilot, while scrolling or lying in bed, or in a focused way at a mirror.

The main differences are physical. They affect the body in different ways, and some practical tools need adjusting:

Some barriers help with both: plasters on your fingertips, thin gloves, short nails, and moving away from close-up mirrors.

Do the same approaches help both?

Yes, mostly. The approaches with the most research behind them for hair pulling have also helped skin picking, so one plan that tackles the shared triggers and urges can cover both.

Habit Reversal Training (HRT) is a behavioural therapy. It teaches you to notice when you’re about to pull or pick, and to do something else with your hands instead (a competing response), such as clenching your fists or pressing your palms flat for a minute. A 2019 review of 10 trials found 8 on hair pulling and 2 on skin picking. The trials pointed the same way: habit reversal reduced symptoms, and in the two picking trials it did better than a waiting list and better than another self-help technique. The reviewers noted weaknesses in many trials, so the evidence is encouraging rather than settled. The UK’s NHS also lists cognitive behavioural therapy (CBT), a talking therapy that works on thoughts, feelings and actions, as a treatment for skin picking, often with habit reversal built in. You can read more in our guide to Habit Reversal Training.

The ComB model (Comprehensive Behavioral model) was built for both. It looks at five areas that keep picking or pulling going: sensations, thoughts, feelings, movements and places. It then matches a strategy to each one. Its developers describe using the same framework for picking and for pulling, shaped to each person’s pattern. Our guide to the ComB model explains how it works.

If you’d like to work through ComB on your own, Overcoming Body-Focused Repetitive Behaviors is a self-help workbook for both hair pulling and skin picking, written by clinicians including the psychologist who developed the ComB model.

Practical steps at home cover both too. Track when and where you pick and pull for a week or two, look for shared hotspots, and keep a textured fidget or smooth stone there. For picking, the NHS also suggests keeping your hands busy and using moisturiser. Our guide on how to stop pulling your hair has a fuller set of practical strategies, most of which work for picking too.

Is medication used for both?

Some have been studied in both, but none is approved specifically for either by the US regulator, the FDA. Two have trial results that include skin picking:

• N-acetylcysteine (NAC), a supplement form of the amino acid cysteine. In a 12-week trial of 66 adults with skin picking disorder, 47% of those who finished on NAC were much improved, compared with 19% on a dummy pill (placebo). Results in hair pulling have been mixed.
• Memantine, a prescription medicine. In an 8-week US trial of 100 adults with hair pulling, skin picking or both, about 6 in 10 of those who finished on memantine were much improved, compared with fewer than 1 in 10 on placebo. Complete relief was rare.

Speak to a doctor or pharmacist before trying any medicine or supplement. Our guides to NAC for trichotillomania and medication for trichotillomania cover the research in more detail.

Where can I get help for both?

Look for one practitioner who understands both. Because the two share the same loop, working on both with one person usually makes more sense than seeing two. When you first get in touch, ask whether they also work with skin picking.

Get support if picking or pulling is causing you distress, taking up a lot of time, or affecting your work, studies or relationships. You don’t need to wait until it’s “bad enough”.

Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory for someone near you. Our guide to finding someone who understands trich explains what to ask on a first call. For an overview of every option and the evidence behind each, see our guide to trichotillomania treatment.

The International OCD Foundation (IOCDF), a US non-profit organisation that supports people with OCD and related conditions, has information and support groups for people who pick and pull on its BFRB pages.

If you’re a parent reading this for your child, start with The Parent’s Guide to Trichotillomania: understanding what your child is going through.

Living with both can feel heavy, and shame often makes it worse. If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call your local emergency number or go to your nearest emergency department.

• Find a helpline (international directory) (findahelpline.com)

Questions people ask

Sources

1. Grant, J.E. & Chamberlain, S.R. (2020). Prevalence of skin picking (excoriation) disorder. Journal of Psychiatric Research.
2. Grant, J.E., Dougherty, D.D. & Chamberlain, S.R. (2020). Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry Research, 288.
3. Grant, J.E., Collins, M., Chamberlain, S.R. & Chesivoir, E. (2024). Disorders of impulsivity in trichotillomania and skin picking disorder. Journal of Psychiatric Research.
4. Snorrason, I., Ricketts, E.J., Flessner, C.A., Franklin, M.E., Stein, D.J. & Woods, D.W. (2012). Skin picking disorder is associated with other body-focused repetitive behaviors: findings from an internet study. Annals of Clinical Psychiatry, 24(4).
5. Lee, M.T., Mpavaenda, D.N. & Fineberg, N.A. (2019). Habit reversal therapy in obsessive compulsive related disorders: a systematic review of the evidence and CONSORT evaluation of randomized controlled trials. Frontiers in Behavioral Neuroscience.
6. Mansueto, C.S. & Golomb, R.G. Comprehensive Behavioral (ComB) treatment for skin picking and hair pulling disorders. International OCD Foundation.
7. Grant, J.E., Chamberlain, S.R., Redden, S.A., et al. (2016). N-acetylcysteine in the treatment of excoriation disorder: a randomized clinical trial. JAMA Psychiatry.
8. UChicago Medicine (2023). New research points to drug option for hair-pulling, skin-picking disorders.
9. International OCD Foundation. Body-focused repetitive behaviors (BFRBs).
10. NHS. Skin picking disorder.
11. Cleveland Clinic. Body-focused repetitive behavior (BFRB).